TY - JOUR
T1 - To Roux or not to Roux
T2 - a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer
AU - Tran, Thuy B.
AU - Worhunsky, David J.
AU - Squires, Malcolm H.
AU - Jin, Linda X.
AU - Spolverato, Gaya
AU - Votanopoulos, Konstantinos I.
AU - Cho, Clifford S.
AU - Weber, Sharon M.
AU - Schmidt, Carl
AU - Levine, Edward A.
AU - Bloomston, Mark
AU - Fields, Ryan C.
AU - Pawlik, Timothy M.
AU - Maithel, Shishir K.
AU - Norton, Jeffrey A.
AU - Poultsides, George A.
N1 - Publisher Copyright:
© 2015, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background: Although the extent of resection frequently dictates the method of reconstruction following distal subtotal gastrectomy, it is unclear whether Roux-en-Y gastrojejunostomy compared with Billroth II gastrojejunostomy is associated with superior perioperative outcomes. Methods: Patients who underwent resection for gastric cancer with Roux-en-Y or Billroth II reconstruction between 2000 and 2012 in seven academic institutions (US Gastric Cancer Collaborative) were identified. Patients who underwent total gastrectomy, gastric wedge, or palliative resections (metastatic disease or R2 resections) were excluded. Results: Of a total of 965 patients, 447 met the inclusion criteria. A comparison between the Roux-en-Y (n = 257) and Billroth II (n = 190) groups demonstrated no differences in patient and tumor characteristics, except for Billroth II patients having a higher proportion of antral tumors (71 % vs. 50 %, p < 0.001). Roux-en-Y operations were slightly longer (244 min vs. 212 min, p < 0.001) and associated with somewhat higher blood loss (243 ml vs. 205 ml, p = 0.033). However, there were no significant differences in the length of hospital stay (8 days vs. 7 days), readmission rate (17 % vs. 18 %), 90-day mortality (5.1 % vs. 4.7 %), incidence (39 % vs. 41 %) and severity of complications, dependency on jejunostomy tube feeding at discharge (13 % vs. 12 %), same-patient decrease in serum albumin level from the preoperative to the postoperative value at 30, 60, and 90 days, receipt of adjuvant therapy (50 % vs. 53 %), or 5-year survival (44 % vs. 41 %). Conclusions: Although long-term quality-of-life parameters were not compared, this study did not show an advantage of Roux-en-Y gastrojejunostomy over Billroth II gastrojejunostomy in short-term perioperative outcomes. Both techniques should be regarded as equally acceptable reconstructive options following partial gastrectomy for gastric cancer.
AB - Background: Although the extent of resection frequently dictates the method of reconstruction following distal subtotal gastrectomy, it is unclear whether Roux-en-Y gastrojejunostomy compared with Billroth II gastrojejunostomy is associated with superior perioperative outcomes. Methods: Patients who underwent resection for gastric cancer with Roux-en-Y or Billroth II reconstruction between 2000 and 2012 in seven academic institutions (US Gastric Cancer Collaborative) were identified. Patients who underwent total gastrectomy, gastric wedge, or palliative resections (metastatic disease or R2 resections) were excluded. Results: Of a total of 965 patients, 447 met the inclusion criteria. A comparison between the Roux-en-Y (n = 257) and Billroth II (n = 190) groups demonstrated no differences in patient and tumor characteristics, except for Billroth II patients having a higher proportion of antral tumors (71 % vs. 50 %, p < 0.001). Roux-en-Y operations were slightly longer (244 min vs. 212 min, p < 0.001) and associated with somewhat higher blood loss (243 ml vs. 205 ml, p = 0.033). However, there were no significant differences in the length of hospital stay (8 days vs. 7 days), readmission rate (17 % vs. 18 %), 90-day mortality (5.1 % vs. 4.7 %), incidence (39 % vs. 41 %) and severity of complications, dependency on jejunostomy tube feeding at discharge (13 % vs. 12 %), same-patient decrease in serum albumin level from the preoperative to the postoperative value at 30, 60, and 90 days, receipt of adjuvant therapy (50 % vs. 53 %), or 5-year survival (44 % vs. 41 %). Conclusions: Although long-term quality-of-life parameters were not compared, this study did not show an advantage of Roux-en-Y gastrojejunostomy over Billroth II gastrojejunostomy in short-term perioperative outcomes. Both techniques should be regarded as equally acceptable reconstructive options following partial gastrectomy for gastric cancer.
KW - Billroth
KW - Gastric cancer
KW - Gastrointestinal reconstruction
KW - Roux-en-Y
UR - http://www.scopus.com/inward/record.url?scp=84944522416&partnerID=8YFLogxK
U2 - 10.1007/s10120-015-0547-3
DO - 10.1007/s10120-015-0547-3
M3 - Article
C2 - 26400843
AN - SCOPUS:84944522416
SN - 1436-3291
VL - 19
SP - 994
EP - 1001
JO - Gastric Cancer
JF - Gastric Cancer
IS - 3
ER -