title: To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer.
abstract: BACKGROUND
  Although the extent of resection frequently dictates the method of reconstruction following distal subtotal gastrectomy, it is unclear whether Roux-en-Y gastrojejunostomy compared with Billroth II gastrojejunostomy is associated with superior perioperative outcomes.
  
  
  METHODS
  Patients who underwent resection for gastric cancer with Roux-en-Y or Billroth II reconstruction between 2000 and 2012 in seven academic institutions (US Gastric Cancer Collaborative) were identified. Patients who underwent total gastrectomy, gastric wedge, or palliative resections (metastatic disease or R2 resections) were excluded.
  
  
  RESULTS
  Of a total of 965 patients, 447 met the inclusion criteria. A comparison between the Roux-en-Y (n = 257) and Billroth II (n = 190) groups demonstrated no differences in patient and tumor characteristics, except for Billroth II patients having a higher proportion of antral tumors (71 % vs. 50 %, p < 0.001). Roux-en-Y operations were slightly longer (244 min vs. 212 min, p < 0.001) and associated with somewhat higher blood loss (243 ml vs. 205 ml, p = 0.033). However, there were no significant differences in the length of hospital stay (8 days vs. 7 days), readmission rate (17 % vs. 18 %), 90-day mortality (5.1 % vs. 4.7 %), incidence (39 % vs. 41 %) and severity of complications, dependency on jejunostomy tube feeding at discharge (13 % vs. 12 %), same-patient decrease in serum albumin level from the preoperative to the postoperative value at 30, 60, and 90 days, receipt of adjuvant therapy (50 % vs. 53 %), or 5-year survival (44 % vs. 41 %).
  
  
  CONCLUSIONS
  Although long-term quality-of-life parameters were not compared, this study did not show an advantage of Roux-en-Y gastrojejunostomy over Billroth II gastrojejunostomy in short-term perioperative outcomes. Both techniques should be regarded as equally acceptable reconstructive options following partial gastrectomy for gastric cancer.
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, 300 Pasteur Drive, Suite H3680D, Stanford, CA, 94305, USA.
authors.forename: Thuy B
authors.initials: TB
authors.lastname: Tran
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, 300 Pasteur Drive, Suite H3680D, Stanford, CA, 94305, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Worhunsky
authors.affiliation: Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Alvin J. Siteman Cancer Center, Washington University, St Louis, MO, USA.
authors.forename: Linda X
authors.initials: LX
authors.lastname: Jin
authors.affiliation: Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.affiliation: Department of Surgery, Ohio State University, Columbus, OH, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.affiliation: Department of Surgery, Ohio State University, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Alvin J. Siteman Cancer Center, Washington University, St Louis, MO, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, 300 Pasteur Drive, Suite H3680D, Stanford, CA, 94305, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, 300 Pasteur Drive, Suite H3680D, Stanford, CA, 94305, USA. gpoultsides@stanford.edu.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Billroth; Gastric cancer; Gastrointestinal reconstruction; Roux-en-Y