Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort study
Abstract Background The optimal standard reconstruction procedure after distal gastrectomy is controversial. No large‐scale persuasive clinical studies from long‐term perspectives on this topic have yet been conducted. Study design This retrospective multicenter study analyzed a database of 2510 con...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-03-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12309 |
| _version_ | 1818608396593528832 |
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| author | Takahiro Kinoshita Michitaka Honda Atsushi Matsuki Naoki Enomoto Masaki Aizawa Souya Nunobe Hiroshi Yabusaki Takayuki Abe Naoki Hiki |
| author_facet | Takahiro Kinoshita Michitaka Honda Atsushi Matsuki Naoki Enomoto Masaki Aizawa Souya Nunobe Hiroshi Yabusaki Takayuki Abe Naoki Hiki |
| author_sort | Takahiro Kinoshita |
| collection | DOAJ |
| description | Abstract Background The optimal standard reconstruction procedure after distal gastrectomy is controversial. No large‐scale persuasive clinical studies from long‐term perspectives on this topic have yet been conducted. Study design This retrospective multicenter study analyzed a database of 2510 consecutive patients with clinical stage I gastric cancer who underwent distal gastrectomy followed by Billroth‐I (B‐I) or Roux‐en‐Y (R‐Y) anastomosis from 2006 to 2012. After adjusting for 30 potential confounding factors using propensity score matching, we compared the body weight loss and other nutritional status for 5 years as primary outcomes between the two groups. We also investigated surgical outcomes, endoscopic findings, and long‐term survival rates as secondary outcomes. Results After matching the inclusion criteria, 940 patients (470 in each group) were enrolled. There was no marked difference in the body weight loss and other nutritional indicators. The incidence of grade ≥3 postoperative complications (Clavien‐Dindo classification) or the incidence of gallstone formation was not markedly different between the two groups. The postoperative hospital stay after surgery was significantly longer, and the readmission rate was significantly higher in the R‐Y group than in the B‐I group. An endoscopic examination revealed no trends regarding the incidence and severity of gastritis or residual food in the remnant stomach. The 5‐year overall survival rate was 92.6% in the B‐I group and 91.8% in the R‐Y group, with no significant difference (P = .379, log‐rank test). Conclusions Roux‐en‐Y reconstruction may be nearly equal to Billroth‐I with regard to the long‐term nutritional perspectives. |
| first_indexed | 2024-12-16T14:41:59Z |
| format | Article |
| id | doaj.art-fc5e443eecf5473abb997edc0565875d |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-12-16T14:41:59Z |
| publishDate | 2020-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-fc5e443eecf5473abb997edc0565875d2022-12-21T22:27:53ZengWileyAnnals of Gastroenterological Surgery2475-03282020-03-014214215010.1002/ags3.12309Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort studyTakahiro Kinoshita0Michitaka Honda1Atsushi Matsuki2Naoki Enomoto3Masaki Aizawa4Souya Nunobe5Hiroshi Yabusaki6Takayuki Abe7Naoki Hiki8Gastric Surgery Division National Cancer Center Hospital East Kashiwa JapanDepartment of Minimally Invasive Surgical and Medical Oncology Fukushima Medical University Fukushima JapanDepartment of Digestive Surgery Niigata Cancer Center Hospital Niigata JapanDepartment of Surgery National Center for Global Health and Medicine Tokyo JapanDepartment of Digestive Surgery Niigata Cancer Center Hospital Niigata JapanDepartoment of Gastroenterological Surgery Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Digestive Surgery Niigata Cancer Center Hospital Niigata JapanDepartment of Biostatistics School of Data Science Yokohama City University Yokohama JapanDepartment of Surgery Kitasato University Sagamihara JapanAbstract Background The optimal standard reconstruction procedure after distal gastrectomy is controversial. No large‐scale persuasive clinical studies from long‐term perspectives on this topic have yet been conducted. Study design This retrospective multicenter study analyzed a database of 2510 consecutive patients with clinical stage I gastric cancer who underwent distal gastrectomy followed by Billroth‐I (B‐I) or Roux‐en‐Y (R‐Y) anastomosis from 2006 to 2012. After adjusting for 30 potential confounding factors using propensity score matching, we compared the body weight loss and other nutritional status for 5 years as primary outcomes between the two groups. We also investigated surgical outcomes, endoscopic findings, and long‐term survival rates as secondary outcomes. Results After matching the inclusion criteria, 940 patients (470 in each group) were enrolled. There was no marked difference in the body weight loss and other nutritional indicators. The incidence of grade ≥3 postoperative complications (Clavien‐Dindo classification) or the incidence of gallstone formation was not markedly different between the two groups. The postoperative hospital stay after surgery was significantly longer, and the readmission rate was significantly higher in the R‐Y group than in the B‐I group. An endoscopic examination revealed no trends regarding the incidence and severity of gastritis or residual food in the remnant stomach. The 5‐year overall survival rate was 92.6% in the B‐I group and 91.8% in the R‐Y group, with no significant difference (P = .379, log‐rank test). Conclusions Roux‐en‐Y reconstruction may be nearly equal to Billroth‐I with regard to the long‐term nutritional perspectives.https://doi.org/10.1002/ags3.12309Billroth‐Igastric cancernutritionRoux‐en‐Ysurvival |
| spellingShingle | Takahiro Kinoshita Michitaka Honda Atsushi Matsuki Naoki Enomoto Masaki Aizawa Souya Nunobe Hiroshi Yabusaki Takayuki Abe Naoki Hiki Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort study Annals of Gastroenterological Surgery Billroth‐I gastric cancer nutrition Roux‐en‐Y survival |
| title | Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort study |
| title_full | Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort study |
| title_fullStr | Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort study |
| title_full_unstemmed | Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort study |
| title_short | Billroth‐I vs Roux‐en‐Y after distal gastrectomy: A comparison of long‐term nutritional status and survival rates from a large‐scale multicenter cohort study |
| title_sort | billroth i vs roux en y after distal gastrectomy a comparison of long term nutritional status and survival rates from a large scale multicenter cohort study |
| topic | Billroth‐I gastric cancer nutrition Roux‐en‐Y survival |
| url | https://doi.org/10.1002/ags3.12309 |
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