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Comparison of the Clinical Outcomes of Reconstruction Methods After Distal Gastrectomy: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

  • Min, Jae-Seok (Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center) ;
  • Kim, Rock Bum (Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital) ;
  • Seo, Kyung Won (Department of Surgery, Kosin University Gospel Hospital) ;
  • Jeong, Sang-Ho (Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital)
  • 투고 : 2022.01.18
  • 심사 : 2022.03.14
  • 발행 : 2022.04.30

초록

Background: To analyze the short- and long-term clinical outcomes of 2 reconstruction methods after distal gastrectomy for gastric cancer. Methods: Three keywords, "gastric neoplasm," "distal gastrectomy," and "reconstruction," were used to search PubMed. We selected only randomized controlled trial that compared the anastomosis methods. A total of 11 papers and 8 studies were included in this meta-analysis. All statistical analyses were performed using the R software. Results: Among short-term clinical outcomes, a shorter operation time, reduced morbidity, and shorter hospital stay were found for Billroth type I (B-I) than for Roux-en-Y (RNY) reconstruction in the meta-analysis (P<0.001, P=0.048, P<0.001, respectively). When comparing Billroth type II (B-II) to RNY, the operation time was shorter for B-II than for RNY (P<0.019), but there were no differences in morbidity or length of hospital stay (P=0.500, P=0.259, respectively).Regarding long-term clinical outcomes related to reflux, there were significantly fewer incidents of reflux esophagitis, reflux gastritis, and bile reflux (P=0.035, P<0.001, P=0.019, respectively) for RNY than for B-I in the meta-analysis, but there was no difference between the 2 methods in residual food (P=0.545). When comparing B-II to RNY, there were significantly fewer incidents of reflux gastritis (P<0.001) for RNY than for B-II, but the amount of residual food and patient weight gain showed no difference. Conclusion: B-I had the most favorable short-term outcomes, but RNY was more advantageous for long-term outcomes than for other methods. Surgeons should be aware of the advantages and disadvantages of each type of anastomosis and select the appropriate method.

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참고문헌

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-249. https://doi.org/10.3322/caac.21660
  2. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Pineros M, Znaor A, et al. Cancer statistics for the year 2020: an overview. Int J Cancer 2021;149:778-789. https://doi.org/10.1002/ijc.33588
  3. Hong S, Won YJ, Lee JJ, Jung KW, Kong HJ, Im JS, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Res Treat 2021;53:301-315. https://doi.org/10.4143/crt.2021.291
  4. Information Committee of the Korean Gastric Cancer Association. Korean gastric cancer association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer 2021;21:221-235. https://doi.org/10.5230/jgc.2021.21.e27
  5. Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019;270:983-991. https://doi.org/10.1097/SLA.0000000000003217
  6. 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;20:1591-1597. https://doi.org/10.1245/s10434-012-2704-9
  7. 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;36:632-637. https://doi.org/10.1007/s00268-011-1408-9
  8. 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;26:1539-1547. https://doi.org/10.1007/s00464-011-2064-8
  9. 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;103:337-347. https://doi.org/10.1002/bjs.10060
  10. 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;15:198-205. https://doi.org/10.1007/s10120-011-0098-1
  11. Yang K, Zhang WH, Liu K, Chen XZ, Zhou ZG, Hu JK. Comparison of quality of life between Billrothcapital I, Ukrainian and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a randomized controlled trial. Sci Rep 2017;7:11245. https://doi.org/10.1038/s41598-017-09676-2
  12. 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;29:1415-1420. https://doi.org/10.1007/s00268-005-7830-0
  13. Choi YY, Noh SH, An JY. A randomized controlled trial of Roux-en-Y gastrojejunostomy vs. gastroduodenostomy with respect to the improvement of type 2 diabetes mellitus after distal gastrectomy in gastric cancer patients. PLoS One 2017;12:e0188904. https://doi.org/10.1371/journal.pone.0188904
  14. So JB, Rao J, Wong AS, Chan YH, Pang NQ, Tay AY, et al. Roux-en-Y or Billroth II reconstruction after radical distal gastrectomy for gastric cancer: a multicenter randomized controlled trial. Ann Surg 2018;267:236-242. https://doi.org/10.1097/SLA.0000000000002229
  15. Yang D, He L, Tong WH, Jia ZF, Su TR, Wang Q. Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis? World J Gastroenterol 2017;23:6350-6356. https://doi.org/10.3748/wjg.v23.i34.6350
  16. Pach R, Orzel-Nowak A, Scully T. Ludwik Rydygier--contributor to modern surgery. Gastric Cancer 2008;11:187-191. https://doi.org/10.1007/s10120-008-0482-7
  17. Hebbard P. Partial gastrectomy and gastrointestinal reconstruction. In: Soybel DI, ed. UpToDate. Alphen aan den Rijn: Wolters Kluwer; 2021.
  18. Ali A, Ahmed BH, Nussbaum MS. Surgery for peptic ulcer disease. In: Yeot CJ, ed. Shackelford's Surgery of the Alimentary Tract, 2 Volume Set. 8th ed. Amsterdam: Elsevier, 2019:673-701.
  19. Moller H, Toftgaard C. Cancer occurrence in a cohort of patients surgically treated for peptic ulcer. Gut 1991;32:740-744. https://doi.org/10.1136/gut.32.7.740
  20. La Vecchia C, Negri E, D'Avanzo B, Moller H, Franceschi S. Partial gastrectomy and subsequent gastric cancer risk. J Epidemiol Community Health 1992;46:12-14. https://doi.org/10.1136/jech.46.1.12
  21. Hori S, Ochiai T, Gunji Y, Hayashi H, Suzuki T. A prospective randomized trial of hand-sutured versus mechanically stapled anastomoses for gastroduodenostomy after distal gastrectomy. Gastric Cancer 2004;7:24-30. https://doi.org/10.1007/s10120-003-0263-2
  22. Hosoda K, Mieno H, Ema A, Ushiku H, Washio M, Song I, et al. Delta-shaped anastomosis vs circular stapler anastomosis after laparoscopic distal gastrectomy with Billroth I reconstruction: a randomized controlled trial. Asian J Endosc Surg 2020;13:301-310. https://doi.org/10.1111/ases.12770
  23. Stanger O. Victor von Hacker (1852-1933)--recollections of the life and works of an important Billroth student. Chirurg 2000;71:478-484. https://doi.org/10.1007/s001040050842
  24. He L, Zhao Y. Is Roux-en-Y or Billroth-II reconstruction the preferred choice for gastric cancer patients undergoing distal gastrectomy when Billroth I reconstruction is not applicable? A meta-analysis. Medicine (Baltimore) 2019;98:e17093. https://doi.org/10.1097/md.0000000000017093
  25. Lindecken KD, Salm B. The effectiveness of Braun's anastomosis in Billroth II surgery. The role of hepatobiliary sequence scintigraphy (HBSS) in the diagnosis of bile flow following stomach resection]. RoFo Fortschr Geb Rontgenstr Nuklearmed 1993;159:158-160. https://doi.org/10.1055/s-2008-1032740
  26. Tersmette AC, Offerhaus GJ, Tersmette KW, Giardiello FM, Moore GW, Tytgat GN, et al. Meta-analysis of the risk of gastric stump cancer: detection of high risk patient subsets for stomach cancer after remote partial gastrectomy for benign conditions. Cancer Res 1990;50:6486-6489.
  27. Hutchison RL, Hutchison AL. Cesar Roux and his original 1893 paper. Obes Surg 2010;20:953-956. https://doi.org/10.1007/s11695-010-0141-z
  28. 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;39:647-651. https://doi.org/10.1007/s00595-009-3964-2
  29. Gustavsson S, Ilstrup DM, Morrison P, Kelly KA. Roux-Y stasis syndrome after gastrectomy. Am J Surg 1988;155:490-494. https://doi.org/10.1016/S0002-9610(88)80120-X
  30. Park YS, Shin DJ, Son SY, Kim KH, Park DJ, Ahn SH, et al. Roux stasis syndrome and gastric food stasis after laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction in gastric cancer patients: a propensity score matching analysis. World J Surg 2018;42:4022-4032. https://doi.org/10.1007/s00268-018-4715-6