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Roux-en-Y Versus Billroth II Gastrojejunostomy After Radical Distal Gastrectomy For Gastric Cancer - A Multicenter Randomized Controlled Trial
Jimmy B. So*1, Ning Qi Pang1, Asim Shabbir1, Amy Yuh Ling Tay1, Yiong Huak Chan1, Man Yee Yung2, Candice Lam2, Zheng Su3, Hong Chui Sim4, Janelle N. Phua1, Katherine Jin San Lee1, Elya Chen1, Andrew Siang Yih Wong4, Jaideepraj Rao3, Enders K. Ng2
1General Surgery, National University Health System, Singapore, Singapore; 2Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong; 3Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore; 4Department of Surgery, Changi General Hospital, 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-centre randomized controlled trial. 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. The primary endpoint was GI Symptoms Score 1 year after surgery. We also compared the peri-operative outcomes, nutritional status, degree of gastritis on endoscopy and quality of life after surgery using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) between the two procedures.
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Results: Operative time was significantly shorter 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 peri-operative morbidity rate of 28.4% and 33.8% respectively (p=0.50) and a peri-operative mortality rate of 1.2% and 2.5% respectively (p=0.62). There were no significant differences in terms of incidence of delayed gastric emptying (B-II n=6, 9.5%; R-Y n=9, 13.4%; p=0.587), median time to resume solid food (B-II 5 days, IQR 4-6; R-Y 5 days, IQR 4-6; p=0.36) and median duration of hospital stay (B-II 9 days, IQR 8-12; R-Y 8 days, IQR 7-12; p=0.20). In terms of GI Symptoms Score, there was no statistically significant difference between B-II (1.36±2.42) and R-Y reconstruction (0.98±1.70, p=0.325). There was also no difference in nutritional status (Nutritional Risk Index of B-II 100.92±7.62 vs R-Y 100.52±8.36, p=0.788). However, patients with B-II were found to have a higher median endoscopic grade for gastritis (B-II 1 [IQR 1-3] vs R-Y 0 [IQR 0-0], p=<0.001). No significant differences were noted in the quality of life after 1 year between the 2 groups.
Conclusion: Our randomized trial shows there is no difference between R-Y and B-II reconstruction after distal gastrectomy in terms of GI symptoms, nutrition and quality of life 1 year after surgery.
 CONSORT Flowchart
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