title: 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.
abstract: OBJECTIVE
  This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer.
  
  
  METHODS
  The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group.
  
  
  RESULTS
  The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis.
  
  
  CONCLUSIONS
  RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.
authors.affiliation: Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Junya
authors.initials: J
authors.lastname: Fujita
authors.forename: Kenji
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kimura
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D004942:Esophagitis, Peptic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000209:etiology; D005763:Gastroenterostomy / Q000009:adverse effects; D005773:Gastroscopy; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D012709:Serum Albumin / Q000378:metabolism; D013274:Stomach Neoplasms / Q000097:blood / Q000601:surgery*; D015431:Weight Loss
chemical_list: D012709:Serum Albumin