• Jimmy Bok-Yan So, Jaideepraj Rao, Andrew Siang-Yih Wong, Yiong-Huak Chan, Ning Qi Pang, Tay Amy Yuh Ling AYL Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore., Man Yee Yung, Zheng Su, Phua Janelle Niam Sin JNS Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore., Asim Shabbir, and Ng Enders Kwok Wai EKW Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong..
• Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore.
• Ann. Surg. 2018 Feb 1; 267 (2): 236-242.

ObjectiveThe aim of the study was to compare the clinical symptoms between Billroth II (B-II) and Roux-en-Y (R-Y) reconstruction after distal subtotal gastrectomy (DG) for gastric cancer.BackgroundSurgery is the mainstay of curative treatment for gastric cancer. The technique for reconstruction after DG remains controversial. Both B-II and R-Y are popular methods.MethodsThis is a prospective multicenter 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 is Gastrointestinal (GI) Symptoms Score 1 year after surgery. We also compared the nutritional status, extent of gastritis on endoscopy, and quality of life after surgery between the 2 procedures at 1 year.ResultsOperative time was significantly shorter for B-II than for R-Y [mean difference 21.5 minutes, 95% confidence interval (95% CI) 3.8-39.3, P = 0.019]. The B-II and R-Y groups had a peri-operative morbidity of 28.4% and 33.8%, respectively (P = 0.500) and a 30-day mortality of 2.5% and 1.2%, respectively (P = 0.500). GI symptoms score did not differ between R-Y versus B-II reconstruction (mean difference -0.45, 95% CI -1.21 to 0.31, P = 0.232). R-Y resulted in a lower median endoscopic grade for gastritis versus B-II (mean difference -1.32, 95% CI -1.67 to -0.98, P < 0.001). We noted no difference in nutritional status (R-Y versus B-II mean difference -0.31, 95% CI -3.27 to 2.65, P = 0.837) and quality of life at 1 year between the 2 groups too.ConclusionAlthough BII is associated with a higher incidence of heartburn symptom and higher median endoscopic grade for gastritis, BII and RY are similar in terms of overall GI symptom score and nutritional status at 1 year after distal gastrectomy.

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