Abstract
Background
The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis.
Methods
In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups.
Results
The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 ± 0.71 vs. 5.83 ± 0.91, P < 0.0001). The bile reflux gastritis at 3 months (P < 0.0001) and 6 months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70).
Conclusions
URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.
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Data Availability
The datasets generated and analyzed during the present study are available from the corresponding author on reasonable request.
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Funding
This work was supported by the grant from the National Natural Science Foundation of China (Key Program 81502401 and 31670828) and Wu Jie-** Medical Foundation (320.6750.17508).
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JW, QW, and GJ planned and designed the research; GJ, YF, CW, and S-QJ, as the main surgeon, who performed each operations in each center; JW, QW, K-LY, QM, and Q-YW as the main investigators and data recorders; K-LY and J-QD tested the feasibility of the study; JW wrote the manuscript; All authors approved the final version of the manuscript.
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Wang, J., Wang, Q., Dong, J. et al. Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial. Ann Surg Oncol 28, 90–96 (2021). https://doi.org/10.1245/s10434-020-08710-4
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DOI: https://doi.org/10.1245/s10434-020-08710-4