Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years.
BACKGROUND
In the majority of gastric surgical units across Japan, Billroth 1 is the preferred method of anastomosis following subtotal distal gastrectomy for gastric cancer. However, across Europe and North America, reconstruction using a Roux-en-Y anastomosis is more common. There is a lack of comparative studies of the two methods focusing on long-term outcome. This study evaluated patient outcome, in terms of adverse gastrointestinal complaints and quality of life, at 5 years following surgery.


METHODS
A total of 652 patients had a subtotal distal gastrectomy for early gastric cancer between January 1993 and December 1999. We studied 229 patients with reconstruction by the Billroth 1 procedure and 214 patients with the Roux-en-Y procedure. All patients had an abdominal ultrasound and endoscopy as part of their follow-up. Quality of life was assessed by questionnaire.


RESULTS
We had an 87% response rate from the questionnaire assessment. The results demonstrated that patients were less likely to experience symptoms of either early or late dumping after Roux-en-Y anastomosis than after Billroth 1. In addition, there were significantly fewer patients with gastritis on endoscopy in the Roux-en-Y group. There was no significant difference in the average relative body weight between the groups. However, patients were more likely to develop gallstones after a Roux-en-Y than after a Billroth 1 reconstruction.


CONCLUSIONS
The results from this study show that, at 5 years, both symptomatically and functionally, Roux-en-Y reconstruction was superior to the Billroth I method after subtotal distal gastrectomy for gastric cancer. However, the overall outcome in both groups was good, with patient satisfaction scores of around 75% in each group.
Nunobe
Souya
S
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Okaro
Abuchi
A
Sasako
Mitsuru
M
Saka
Makoto
M
Fukagawa
Takeo
T
Katai
Hitoshi
H
Sano
Takeshi
T
D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D005260:Female; D005743:Gastrectomy; D005763:Gastroenterostomy / Q000009:adverse effects*; D006801:Humans; D007564:Japan; D008297:Male; D011178:Postgastrectomy Syndromes / Q000175:diagnosis*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome