|
|
Back to 2015 Annual Meeting Program
Perioperative Outcomes After Billroth II Versus Roux-EN-Y Reconstruction After Radical Distal Gastrectomy for Cancer - a Multi-Centre Randomized Controlled Trial
Jimmy B. so1, Jaideepraj Rao2, Ning QI Pang*1, Andrew S. Wong4, Amy Yuh Ling Tay1, Man Yee Yung3, Zheng Su2, Hong Chui SIM4, Janelle Niam Sin Phua5, Asim Shabbir1, Enders K. NG3
1General Surgery, National University Health System, Singapore, Singapore; 2Tan Tock Seng Hospital, Singapore, Singapore; 3Prince of Wales Hospital, Hong Kong, Hong Kong; 4Changi General Hospital, Singapore, Singapore; 5National University of Singapore, Singapore, Singapore
Background: Surgery is the mainstay of treatment for resectable gastric cancer. However, the method of reconstruction after distal subtotal gastrectomy (DG) is still a matter of debate. Both Billroth II (B-II) and Roux-en-Y (R-Y) remain accepted as standard of care.
Methods: This is a prospective multi-center randomized controlled trial (RCT). Patients who underwent an open or laparoscopic radical DG with curative intent for gastric cancer were randomized into either B-II or R-Y reconstruction. In this study, B-II reconstruction was performed without an additional Braun anastomosis, and the creation of the R-Y jejuno-jejunostomy was done at 40cm of the Roux limb. We measured nutritional status, gastrointestinal (GI) symptoms and quality of life up to 2 years after surgery. The primary endpoint was GI symptoms score 1 year after surgery. This is a report on the feasibility and peri-operative outcomes of the study.
Results: From October 2008 to October 2014, 162 patients who underwent DG were randomly allocated to B-II (n=81) and R-Y (n=81) groups. A significant difference was noted in the operative time taken for B-II (247.3 ± 56.7min) compared to R-Y (270.3 ± 58.7min, p=0.012). The B-II and R-Y groups had a morbidity rate of 28.4% and 33.8% respectively (p=0.50) and mortality rate of 1.2% and 2.5% respectively (p=0.62). There were no significant differences in terms of median duration of hospital stay (B-II 9 days, IQR 8-12; R-Y 8 day, IQR 7-12; p=0.20) and median time to resume solid food (B-II 5 days, IQR 4-6; R-Y 5 days, IQR 4-6; p=0.36).
Conclusion: This is the first multi-center international RCT on gastric cancer surgery in our region. Our early post-operative outcome data shows that both procedures were safe with no significant differences between B-II and R-Y. We await the outcome of our primary endpoint to compare the 2 reconstruction methods.
Back to 2015 Annual Meeting Program
|
