Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database.

Moon-Won Yoo, Kyung Sook Yang, Bo-Ra Keum, Sung Il Choi, Seong Ho Hwang, Myoung Won Son, In Ho Jeong, Sang Hyuk Seo, Young-Gil Son, Chang-Min Lee, Hoon Hur, Sun-Hwi Hwang, Han Hong Lee, Shin-Hoo Park, Mi Ran Jung, Hyuk Soon Choi, Sungsoo Park, Chang Hyun Kim, Sung Jin Oh, Moon-Soo Lee, Jong-Hyun Park

Journal: International journal of surgery (London, England) 2024;110(1):32-44

PMID: 37755373

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Abstract

BACKGROUNDS

This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG).

MATERIALS AND METHODS

We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups.

RESULTS

In endoscopic findings, bile reflux was the lowest in the RY group ( n =67), followed by the BII-B ( n =183) and BII groups ( n =147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P <0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups.

CONCLUSIONS

BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.

Address: Division of Foregut Surgery, Korea University College of Medicine, Seoul.; Division of Foregut Surgery, Korea University Anam Hospital, Seoul.; Department of Surgery, Ajou University School of Medicine, Suwon.; Division of Foregut Surgery, Korea University College of Medicine, Seoul.; Division of Foregut Surgery, Korea University College of Medicine, Seoul.; Department of Surgery, Korea University Ansan Hospital, Ansan.; Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu.; Department of Surgery, Chonnam National University Medical School, Jeollanam-do.; Department of Surgery, Catholic University of Seoul St Mary's Hospital, Seoul, Republic of Korea.; Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.; Department of Surgery, Eulji University Hospital, Daejeon.; Department of Surgery, Busan Paik Hospital, Inje University.; Department of Surgery, Jeju National University School of Medicine, Jeju.; Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan.; Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul.; Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul.; Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan.; Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea.; Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul.; Department of Internal Medicine, Korea University College of Medicine, Seoul.; Department of Biostatistics, Korea University College of Medicine, Seoul.

DOI: 10.1097/JS9.0000000000000796

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MeSH Terms: Humans, Quality of Life, Gastrectomy, Bile Reflux, Prospective Studies, Postoperative Complications, Gastroenterostomy, Anastomosis, Roux-en-Y, Stomach Neoplasms, Nausea, Treatment Outcome