Comparison of perioperative safety and middle-long term complications of Roux-en-Y and Billroth-Ⅰreconstructions after distal subtotal gastrectomy: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIN Xiaoguang ¹ ,  BAI Rixing ¹ , YAN Wenmao ¹ , SONG Maomin ¹ , LI Xiaobo ²

1. Department of General Surgery, Tiantan Hospital of Capital Medical University, Beijing 100050, P.R.China;
2. Center of Experiment, The Second Affiliated Hospital of Soochow University, Suzou, Jiangsu 215004, P.R.China;

Corresponding?author：

BAI Rixing, Email: brx5168@163.com

Keywords：

distal subtotal gastrectomy; reconstruction; meta-analysis; Billroth-Ⅰanastomosis; Roux-en-Y anastomosis

DOI：

10.7507/1007-9424.201606008

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Objective To systematically review perioperative safety and middle-term and long-term complications of Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis after distal subtotal gastrectomy by a meta-analysis. Methods Literatures about Roux-en-Y and Billroth-Ⅰ anastomoses after distal subtotal gastrectomy in Embase, PubMed, MedLine, and the Cochrane Library databases were searched. Retrieval time was from December 1, 2015 to March 1, 2016. According to the inclusion and exclusion criteria, two reviewers independently screened literatures, extracted data, and evaluated the qualities of the included studies. Then meta-analysis was performed using Review Manager Version 5.1 software. Results Five randomized controlled trials (RCTs) were finally included involving 600 patients, of which 302 patients were underwent Roux-en-Y anasomosis, 298 patients were underwent Billroth-Ⅰ anasomosis. The results of meta-analysis showed that the Billroth-Ⅰ anastomosis operation had more advantages in the operative time 〔WMD: 38.95; 95%CI: (19.86, 58.04);P<0.000 1〕 and the intraoperative bleeding 〔WMD: 34.85; 95%CI: (2.13, 67.56);P=0.04〕. However, the Roux-en-Y anastomosis had more significant effects in the prevention of bile reflux 〔OR: 0.03; 95%CI: (0.01, 0.11);P<0.000 01〕 and the residual gastritis 〔OR: 0.37; 95%CI: (0.25, 0.54);P<0.000 01〕. There were no differences in the hospital stay 〔WMD: 2.96; 95%CI: (–0.00, 5.93);P=0.05〕, anastomotic leakage 〔OR: 0.43; 95%CI: (0.11, 1.68);P=0.23〕, anastomotic stricture 〔OR: 1.84; 95%CI: (0.61, 5.53);P=0.27〕, reflux esophagitis〔OR: 0.63; 95%CI: (0.28, 1.44);P=0.27〕, and delayed gastric emptying 〔OR: 1.24; 95%CI: (0.46, 3.30);P=0.67〕 between the Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis. Conclusions Billroth- I anastomosis and Roux-en-Y anastomosis have their own advantages and disadvantages, in term of safety of Billroth- I anastomosis is better, but it’s quality of life is worse as compared with Roux-en-Y anastomosis. However, more high-quality, well-designed, adequate RCTs data are needed to validate.

Citation： QINXiaoguang, BAIRixing, YANWenmao, SONGMaomin, LIXiaobo. Comparison of perioperative safety and middle-long term complications of Roux-en-Y and Billroth-Ⅰreconstructions after distal subtotal gastrectomy: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 201-209. doi: 10.7507/1007-9424.201606008 Copy

1.	?鄒小農, 孫喜斌, 陳萬青, 等. 2003-2007 年中國胃癌發病與死亡情況分析. 腫瘤, 2012, 32(2): 109-114.
2.	Leung WK, Wu MS, Kakugawa Y,et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol, 2008, 9(3): 279-287.
3.	Imamura H, Takiguchi S, Yamamoto K,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): 632-637.
4.	Lee MS, Ahn SH, Lee JH,et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc, 2012, 26(6): 1539-1547.
5.	Ishikawa M, Kitayama J, Kaizaki 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): 1415-1421.
6.	Nakamura M, Nakamori M, Ojima T,et al. Randomized clinical trial comparing long-term quality of life for Billroth Ⅰversus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg, 2016, 103(4): 337-347.
7.	Hirao M, Takiguchi S, Imamura H,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): 1591-1597.
8.	Xiong JJ, Altaf K, Javed MA,et al. Roux-en-Yversus Billroth Ⅰ reconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol, 2013, 19(7): 1124-1134.
9.	曹先東, 郭愛軍. 胃癌術后吻合口狹窄. 安徽醫科大學學報, 1997, 32(5): 584-585.
10.	Muehrcke DD, Kaplan DK, Donnelly RJ,et al. Anastomotic narrowing after esophagogastrectomy with the EEA stapling device. Thorac Cardiovasc Surg, 1989, 97(3): 434-438.
11.	季加孚, 季鑫. 胃癌根治術后消化道重建的原則與進展. 中華普外科手術學雜志(電子版), 2014, 8(4): 285-288.
12.	Hoya Y, Mitsumori N, Yanaga K. The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. Surg Today, 2009, 39(8): 647-651.
13.	Efstathiadou Z, Bitsis S, Milionis HJ,et al. Lipid profile in subclinical hypothyroidism: is L-thyroxine substitution beneficial? Eur J Endocrinol, 2001, 145(6): 705-710.
14.	Zhang YM, Liu XL, Xue DB,et al. Myoelectric activity and motility of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy. World J Gastroenterol, 2006, 12(47): 7699-7704.
15.	雷勇, 王吉甫. 全胃切除術后 Roux-Y 空腸袢動力變化的臨床研究. 中華胃腸外科雜志, 1999, 2(1): 38-40.
16.	Zong L, Chen P. Billroth Ⅰvs Billroth Ⅱvs. Roux-en-Y following distal gastrectomy: a meta-analysis based on 15 studies. Hepatogastroenterology, 2011, 58(109): 1413-1424.
17.	Collard M, Romagnoli R. Roux-en-Y jejunal loop and bile reflux. Am J Surg, 2000, 179(4): 298-303.
18.	Osugi H, Fukuhara K, Takada N,et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology, 2004, 51(58): 1215-1218.
19.	Wetscher J, Hinder A, Smyrk T,et al. Gastric acid blockade with omeprazole promotes gastric carcinogenesis induced by duodenogastric reflux. Dig Dis Sci, 1999, 44(6): 1132-1135.
20.	Csendes A, Burgos AM, Smok G,et al. Latest results (12-21 years) of a prospective randomized study comparing Billroth Ⅱand Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg, 2009, 249(2): 189-194.
21.	馬浙夫, 王忠裕, 張俊然. 殘胃返流液致癌性的探討. 中國實用外科雜志, 2001, 21(4): 225-227.
22.	Montesani C, D’Amato A, Santella S,et al. Billroth Ⅰversus Billroth Ⅱversus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study. Hepatogastroenterology, 2002, 49(47): 1469-1473.
23.	Namikawa T, Kitagawa H, Okabayashi T,et al. 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(6): 769-776.
24.	Namikawa T, Kitagawa H, Okabayashi T,et al. Roux-en-Y reconstruction is superior to billrothⅠ reconstruction in reducing reflux esophagitis after distal gastrectomy: special relationship with the angle of His. World J Surg, 2010, 34(5): 1022-1027.
25.	Kojima K, Yamada H, Inokuchi M,et al. A comparison of Roux-en-Y and BillrothⅠ reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg, 2008, 247(6): 962-967.
26.	Nunobe S, Okaro A, Sasako M,et al. Billroth 1versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years. Int J Clin Oncol, 2007, 12(6): 433-439.

1. ?鄒小農, 孫喜斌, 陳萬青, 等. 2003-2007 年中國胃癌發病與死亡情況分析. 腫瘤, 2012, 32(2): 109-114.
2. Leung WK, Wu MS, Kakugawa Y,et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol, 2008, 9(3): 279-287.
3. Imamura H, Takiguchi S, Yamamoto K,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): 632-637.
4. Lee MS, Ahn SH, Lee JH,et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc, 2012, 26(6): 1539-1547.
5. Ishikawa M, Kitayama J, Kaizaki 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): 1415-1421.
6. Nakamura M, Nakamori M, Ojima T,et al. Randomized clinical trial comparing long-term quality of life for Billroth Ⅰversus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg, 2016, 103(4): 337-347.
7. Hirao M, Takiguchi S, Imamura H,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): 1591-1597.
8. Xiong JJ, Altaf K, Javed MA,et al. Roux-en-Yversus Billroth Ⅰ reconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol, 2013, 19(7): 1124-1134.
9. 曹先東, 郭愛軍. 胃癌術后吻合口狹窄. 安徽醫科大學學報, 1997, 32(5): 584-585.
10. Muehrcke DD, Kaplan DK, Donnelly RJ,et al. Anastomotic narrowing after esophagogastrectomy with the EEA stapling device. Thorac Cardiovasc Surg, 1989, 97(3): 434-438.
11. 季加孚, 季鑫. 胃癌根治術后消化道重建的原則與進展. 中華普外科手術學雜志(電子版), 2014, 8(4): 285-288.
12. Hoya Y, Mitsumori N, Yanaga K. The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. Surg Today, 2009, 39(8): 647-651.
13. Efstathiadou Z, Bitsis S, Milionis HJ,et al. Lipid profile in subclinical hypothyroidism: is L-thyroxine substitution beneficial? Eur J Endocrinol, 2001, 145(6): 705-710.
14. Zhang YM, Liu XL, Xue DB,et al. Myoelectric activity and motility of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy. World J Gastroenterol, 2006, 12(47): 7699-7704.
15. 雷勇, 王吉甫. 全胃切除術后 Roux-Y 空腸袢動力變化的臨床研究. 中華胃腸外科雜志, 1999, 2(1): 38-40.
16. Zong L, Chen P. Billroth Ⅰvs Billroth Ⅱvs. Roux-en-Y following distal gastrectomy: a meta-analysis based on 15 studies. Hepatogastroenterology, 2011, 58(109): 1413-1424.
17. Collard M, Romagnoli R. Roux-en-Y jejunal loop and bile reflux. Am J Surg, 2000, 179(4): 298-303.
18. Osugi H, Fukuhara K, Takada N,et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology, 2004, 51(58): 1215-1218.
19. Wetscher J, Hinder A, Smyrk T,et al. Gastric acid blockade with omeprazole promotes gastric carcinogenesis induced by duodenogastric reflux. Dig Dis Sci, 1999, 44(6): 1132-1135.
20. Csendes A, Burgos AM, Smok G,et al. Latest results (12-21 years) of a prospective randomized study comparing Billroth Ⅱand Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg, 2009, 249(2): 189-194.
21. 馬浙夫, 王忠裕, 張俊然. 殘胃返流液致癌性的探討. 中國實用外科雜志, 2001, 21(4): 225-227.
22. Montesani C, D’Amato A, Santella S,et al. Billroth Ⅰversus Billroth Ⅱversus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study. Hepatogastroenterology, 2002, 49(47): 1469-1473.
23. Namikawa T, Kitagawa H, Okabayashi T,et al. 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(6): 769-776.
24. Namikawa T, Kitagawa H, Okabayashi T,et al. Roux-en-Y reconstruction is superior to billrothⅠ reconstruction in reducing reflux esophagitis after distal gastrectomy: special relationship with the angle of His. World J Surg, 2010, 34(5): 1022-1027.
25. Kojima K, Yamada H, Inokuchi M,et al. A comparison of Roux-en-Y and BillrothⅠ reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg, 2008, 247(6): 962-967.
26. Nunobe S, Okaro A, Sasako M,et al. Billroth 1versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years. Int J Clin Oncol, 2007, 12(6): 433-439.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of perioperative safety and middle-long term complications of Roux-en-Y and Billroth-Ⅰreconstructions after distal subtotal gastrectomy: a meta-analysis

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