title: Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: a meta-analysis.
abstract: OBJECTIVE
  To conduct a meta-analysis to compare Roux-en-Y (R-Y) gastrojejunostomy with gastroduodenal Billroth I (B-I) anastomosis after distal gastrectomy (DG) for gastric cancer.
  
  
  METHODS
  A literature search was performed to identify studies comparing R-Y with B-I after DG for gastric cancer from January 1990 to November 2012 in Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95%CI were calculated using either ﬁxed or random effects model. Operative outcomes such as operation time, intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture, bile reﬂux, remnant gastritis, reﬂux esophagitis, dumping symptoms, delayed gastric emptying and hospital stay were the main outcomes assessed. Meta-analyses were performed using RevMan 5.0 software (Cochrane library).
  
  
  RESULTS
  Four randomized controlled trials (RCTs) and 9 non-randomized observational clinical studies (OCS) involving 478 and 1402 patients respectively were included. Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile reﬂux (OR 0.04, 95%CI: 0.01, 0.14; P < 0.00 001) and remnant gastritis (OR 0.43, 95%CI: 0.28, 0.66; P = 0.0001), however needing a longer operation time (WMD 40.02, 95%CI: 13.93, 66.11; P = 0.003). Meta-analysis of OCS also revealed R-Y reconstruction had a lower incidence of bile reﬂux (OR 0.21, 95%CI: 0.08, 0.54; P = 0.001), remnant gastritis (OR 0.18, 95%CI: 0.11, 0.29; P < 0.00 001) and reﬂux esophagitis (OR 0.48, 95%CI: 0.26, 0.89; P = 0.02). However, this reconstruction method was found to be associated with a longer operation time (WMD 31.30, 95%CI: 12.99, 49.60; P = 0.0008).
  
  
  CONCLUSIONS
  This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-I reconstruction post DG. However there is a need for further adequately powered, well-designed RCTs comparing the same.
authors: Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors: Jun-Jie
authors: JJ
authors: Xiong
authors: Kiran
authors: K
authors: Altaf
authors: Muhammad A
authors: MA
authors: Javed
authors: Quentin M
authors: QM
authors: Nunes
authors: Wei
authors: W
authors: Huang
authors: Gang
authors: G
authors: Mai
authors: Chun-Lu
authors: CL
authors: Tan
authors: Rajarshi
authors: R
authors: Mukherjee
authors: Robert
authors: R
authors: Sutton
authors: Wei-Ming
authors: WM
authors: Hu
authors: Xu-Bao
authors: XB
authors: Liu
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D005763:Gastroenterostomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Billroth I; Distal gastrectomy; Gastric cancer; Meta-analysis; Reconstruction; Roux-en-Y