Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: European Surgery 5/2018

04.05.2018 | review

Roux-en-Y versus Billroth I following distal gastrectomy

A meta-analysis

verfasst von: Haizhong Liu, Yujie Li

Erschienen in: European Surgery | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Aim

The aim of this study was to assess and validate the clinical efficacy of Roux-en-Y reconstruction (R-Y) when compared to Billroth I reconstruction (B-I) after distal gastrectomy (DG).

Methods

The authors identified the prospective, randomized, controlled trials comparing R‑Y with B‑I after DG for gastric cancer from January 1990 to July 2016 using PubMed, Web of Knowledge, Ovid’s database. The method of meta-analysis is performed to compare the complications and recurrences of R‑Y versus B‑I.

Result

Seven randomized controlled trials (RCTs) involving 1197 patients were included. Meta-analysis revealed that R‑Y reconstruction was associated with a significant reduction in the incidence of remnant gastritis (Odds ratios [OR] 2.58, 95%Confidence interval [CI]: 1.78, 3.74; P < 0.00001). No significant differences were observed between the groups in terms of intraoperative blood loss (Weighted mean difference [WMD] −20.97, 95%CI: −47.85, 5.92; P = 0.13), time to resumed oral intake (WMD −1.32, 95%CI: −6.39, 3.75; P = 0.61), reflux esophagitis (OR 1.71, 95%CI: 0.82, 3.57; P = 0.15), and recurrence (OR 1.10, 95%CI: 0.44, 2.71; P = 0.84). Moreover, the B‑I reconstruction method took significantly less time to perform as compared to R‑Y reconstruction (WMD −38.12, 95%CI: −50.50, −25.74; P < 0.00001) and postoperative hospital stay was shorter (WMD −2.96, 95%CI: −5.93, 0.00; P = 0.05),

Conclusion

The R‑Y reconstruction was effective in preventing gastritis, although R‑Y reconstruction after gastric resection was inferior to B‑I reconstruction in terms of taking more time to perform and a longer stay in hospital.

Sie möchten Zugang zu diesem Inhalt erhalten? Dann informieren Sie sich jetzt über unsere Produkte:

Abo für kostenpflichtige Inhalte

Literatur
1.
Zurück zum Zitat Yoshino K. History of gastric cancer surgery. Nihon Geka Gakkai Zasshi. 2000;101:855–60. PubMed Yoshino K. History of gastric cancer surgery. Nihon Geka Gakkai Zasshi. 2000;101:855–60. PubMed
2.
Zurück zum Zitat Weil PH, Buchberger R. From Billroth to PCV: a century of gastric surgery. World J Surg. 1999;23:736–42. CrossRef Weil PH, Buchberger R. From Billroth to PCV: a century of gastric surgery. World J Surg. 1999;23:736–42. CrossRef
3.
Zurück zum Zitat Fukuhara K, Osugi H, Takada N, Takemura M, Higashino M, Kinoshita H. Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux. World J Surg. 2002;26:1452–7. CrossRef Fukuhara K, Osugi H, Takada N, Takemura M, Higashino M, Kinoshita H. Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux. World J Surg. 2002;26:1452–7. CrossRef
4.
Zurück zum Zitat Osugi H, Fukuhara K, Takada N, Takemura M, Kinoshita H. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology. 2004;51:1215–8. PubMed Osugi H, Fukuhara K, Takada N, Takemura M, Kinoshita H. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology. 2004;51:1215–8. PubMed
5.
Zurück zum Zitat Kauer WK, Peters JH, DeMeester TR, Feussner H, Ireland AP, Stein HJ, et al. Composition and concentration of bile acid reflux into the esophagus of patients with gastroesophageal reflux disease. Surgery. 1997;122:874–81. CrossRef Kauer WK, Peters JH, DeMeester TR, Feussner H, Ireland AP, Stein HJ, et al. Composition and concentration of bile acid reflux into the esophagus of patients with gastroesophageal reflux disease. Surgery. 1997;122:874–81. CrossRef
6.
Zurück zum Zitat Kiesslich R, Kanzler S, Vieth M, Moehler M, Neidig J, Thanka Nadar BJ, et al. Minimal change esophagitis: prospective comparison of endoscopic and histological markers between patients with non-erosive reflux disease and normal controls using magnifying endoscopy. Dig Dis. 2004;22:221–7. CrossRef Kiesslich R, Kanzler S, Vieth M, Moehler M, Neidig J, Thanka Nadar BJ, et al. Minimal change esophagitis: prospective comparison of endoscopic and histological markers between patients with non-erosive reflux disease and normal controls using magnifying endoscopy. Dig Dis. 2004;22:221–7. CrossRef
7.
Zurück zum Zitat Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K. A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg. 2008;247:962–7. CrossRef Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K. A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg. 2008;247:962–7. CrossRef
8.
Zurück zum Zitat Xiong JJ, Altaf K, Javed MA, et al. Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol. 2013;19:1124–34. CrossRef Xiong JJ, Altaf K, Javed MA, et al. Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol. 2013;19:1124–34. CrossRef
9.
Zurück zum Zitat Zong L, Chen P. Billroth I vs. Billroth II vs. Roux-en-Y following distal gastrectomy: a meta-analysis based on 15 studies. Hepatogastroenterology. 2011;58(109):1413–24. CrossRef Zong L, Chen P. Billroth I vs. Billroth II vs. Roux-en-Y following distal gastrectomy: a meta-analysis based on 15 studies. Hepatogastroenterology. 2011;58(109):1413–24. CrossRef
10.
Zurück zum Zitat Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
11.
Zurück zum Zitat Imamura H, Takiguchi S, Yamamoto K, Hirao M, Fujita J, Miyashiro I, et al. Morbidity and mortality results from a prospective randomized controlled trial comparing Billroth I and Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer. World J Surg. 2012;36(3):632–7. CrossRef Imamura H, Takiguchi S, Yamamoto K, Hirao M, Fujita J, Miyashiro I, et al. Morbidity and mortality results from a prospective randomized controlled trial comparing Billroth I and Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer. World J Surg. 2012;36(3):632–7. CrossRef
12.
Zurück zum Zitat Hirao M, Takiguchi S, Imamura H, Yamamoto K, Kurokawa Y, Fujita J, et al. Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol. 2013;20(5):1591–7. CrossRef Hirao M, Takiguchi S, Imamura H, Yamamoto K, Kurokawa Y, Fujita J, et al. Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol. 2013;20(5):1591–7. CrossRef
13.
Zurück zum Zitat Ishikawa M, Kitayama J, Kaizaki S, Nakayama H, Ishigami H, Fujii S, et al. Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg. 2005;29(11):1415–20. discussion 1421. CrossRef Ishikawa M, Kitayama J, Kaizaki S, Nakayama H, Ishigami H, Fujii S, et al. Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg. 2005;29(11):1415–20. discussion 1421. CrossRef
14.
Zurück zum Zitat Lee MS, Ahn SH, Lee JH, Park DJ, Lee HJ, Kim HH, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc. 2012;26(6):1539–47. CrossRef Lee MS, Ahn SH, Lee JH, Park DJ, Lee HJ, Kim HH, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc. 2012;26(6):1539–47. CrossRef
15.
Zurück zum Zitat Montesani C, D’Amato A, Santella S, Pronio A, Giovannini C, Cristaldi M, et al. Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study. Hepatogastroenterology. 2002;49(47):1469–73. PubMed Montesani C, D’Amato A, Santella S, Pronio A, Giovannini C, Cristaldi M, et al. Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study. Hepatogastroenterology. 2002;49(47):1469–73. PubMed
16.
Zurück zum Zitat Nakamura M, Nakamori M, Ojima T, Iwahashi M, Horiuchi T, Kobayashi Y, et al. Randomized clinical trial comparing long-term quality of life for Billroth I versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg. 2016;103(4):337–47. CrossRef Nakamura M, Nakamori M, Ojima T, Iwahashi M, Horiuchi T, Kobayashi Y, et al. Randomized clinical trial comparing long-term quality of life for Billroth I versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg. 2016;103(4):337–47. CrossRef
17.
Zurück zum Zitat Takiguchi S, Yamamoto K, Hirao M, Imamura H, Fujita J, Yano M, et al. A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT. Gastric Cancer. 2012;15(2):198–205. CrossRef Takiguchi S, Yamamoto K, Hirao M, Imamura H, Fujita J, Yano M, et al. A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT. Gastric Cancer. 2012;15(2):198–205. CrossRef
18.
Zurück zum Zitat Tanaka K, Takiguchi S, Miyashiro I, Hirao M, Yamamoto K, Imamura H, et al. Impact of reconstruction method on visceral fat change after distal gastrectomy: results from a randomized controlled trial comparing Billroth I reconstruction and roux-en-Y reconstruction. Surgery. 2014;155(3):424–31. CrossRef Tanaka K, Takiguchi S, Miyashiro I, Hirao M, Yamamoto K, Imamura H, et al. Impact of reconstruction method on visceral fat change after distal gastrectomy: results from a randomized controlled trial comparing Billroth I reconstruction and roux-en-Y reconstruction. Surgery. 2014;155(3):424–31. CrossRef
19.
Zurück zum Zitat Piessen G, Triboulet JP, Mariette C. Reconstruction after gastrectomy: which technique is best? J Visc Surg. 2010;147:e273–e83. CrossRef Piessen G, Triboulet JP, Mariette C. Reconstruction after gastrectomy: which technique is best? J Visc Surg. 2010;147:e273–e83. CrossRef
20.
Zurück zum Zitat Fukuhara K, Osugi H, Takada N, Takemura M, Ohmoto Y, Kinoshita H. Quantitative determinations of duodenogastric reflux, prevalence of Helicobacter pyroli infection, and concentrations of interleukin-8. World J Surg. 2003;27:567–70. CrossRef Fukuhara K, Osugi H, Takada N, Takemura M, Ohmoto Y, Kinoshita H. Quantitative determinations of duodenogastric reflux, prevalence of Helicobacter pyroli infection, and concentrations of interleukin-8. World J Surg. 2003;27:567–70. CrossRef
21.
Zurück zum Zitat Shinoto K, Ochiai T, Suzuki T, Okazumi S, Ozaki M. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today. 2003;33:169–77. CrossRef Shinoto K, Ochiai T, Suzuki T, Okazumi S, Ozaki M. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today. 2003;33:169–77. CrossRef
22.
Zurück zum Zitat Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5:83–9. CrossRef Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5:83–9. CrossRef
23.
Zurück zum Zitat Sato T, Miwa K, Sahara H, Segawa M, Hattori T. The sequential model of Barrett’s esophagus and adenocarcinoma induced by duodeno-esophageal reflux without exogenous carcinogens. Anticancer Res. 2002;22:39–44. PubMed Sato T, Miwa K, Sahara H, Segawa M, Hattori T. The sequential model of Barrett’s esophagus and adenocarcinoma induced by duodeno-esophageal reflux without exogenous carcinogens. Anticancer Res. 2002;22:39–44. PubMed
24.
Zurück zum Zitat Wetscher GJ, Hinder RA, Smyrk T, Perdikis G, Adrian TE, Profanter C. Gastric acid blockade with omeprazole promotes gastric carcinogenesis induced by duodenogastric reflux. Dig Dis Sci. 1999;44:1132–5. CrossRef Wetscher GJ, Hinder RA, Smyrk T, Perdikis G, Adrian TE, Profanter C. Gastric acid blockade with omeprazole promotes gastric carcinogenesis induced by duodenogastric reflux. Dig Dis Sci. 1999;44:1132–5. CrossRef
25.
Zurück zum Zitat Namikawa T, Kitagawa H, Okabayashi T, Sugimoto T, Kobayashi M, Hanazaki K. Double tract reconstruction after distal gastrectomy for gastric cancer is effective in reducing reflux esophagitis and remnant gastritis with duodenal passage preservation. Langenbecks Arch Surg. 2011;396:769–76. CrossRef Namikawa T, Kitagawa H, Okabayashi T, Sugimoto T, Kobayashi M, Hanazaki K. Double tract reconstruction after distal gastrectomy for gastric cancer is effective in reducing reflux esophagitis and remnant gastritis with duodenal passage preservation. Langenbecks Arch Surg. 2011;396:769–76. CrossRef
26.
Zurück zum Zitat Fisher BL, Buchwald H, Clark W, Champion JK, Fox SR, MacDonald KG, et al. Mini-gastric bypass controversy. Obes Surg. 2001;11:773–7. CrossRef Fisher BL, Buchwald H, Clark W, Champion JK, Fox SR, MacDonald KG, et al. Mini-gastric bypass controversy. Obes Surg. 2001;11:773–7. CrossRef
27.
Zurück zum Zitat Langhans P, Heger RA, Stegemann B. The cancer risk in the stomach subjected to nonresecting procedures. An experimental long-term study. Scand J Gastroenterol Suppl. 1984;92:138–41. PubMed Langhans P, Heger RA, Stegemann B. The cancer risk in the stomach subjected to nonresecting procedures. An experimental long-term study. Scand J Gastroenterol Suppl. 1984;92:138–41. PubMed
Metadaten
Titel
Roux-en-Y versus Billroth I following distal gastrectomy
A meta-analysis
verfasst von
Haizhong Liu
Yujie Li
Publikationsdatum
04.05.2018
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 5/2018
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-018-0532-2