title: Randomized clinical trial comparing long-term quality of life for Billroth I versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.
abstract: BACKGROUND
  Patients' quality of life (QoL) deteriorates remarkably after gastrectomy. Billroth I reconstruction following distal gastrectomy has the physiological advantage of allowing food to pass through the duodenum. It was hypothesized that Billroth I reconstruction would be superior to Roux-en-Y reconstruction in terms of long-term QoL after distal gastrectomy. This study compared two reconstructions in a multicentre prospective randomized clinical trial to identify the optimal reconstruction procedure.
  
  
  METHODS
  Between January 2009 and September 2010, patients who underwent gastrectomy for gastric cancer were randomized during surgery to Billroth I or Roux-en-Y reconstruction. The primary endpoint was assessment of QoL using the Functional Assessment of Cancer Therapy - Gastric (FACT-Ga) questionnaire 36 months after surgery.
  
  
  RESULTS
  A total of 122 patients were enrolled in the study, 60 to Billroth I and 62 to Roux-en-Y reconstruction. There were no differences between the two groups in terms of postoperative complications or mortality, and no significant differences in FACT-Ga total score (P = 0·496). Symptom scales such as epigastric fullness (heaviness), diarrhoea and fatigue were significantly better in the Billroth I group at 36 months after gastrectomy (heaviness, P = 0·040; diarrhoea, P = 0·046; fatigue, P = 0·029). The rate of weight loss in the third year was lower for patients in the Billroth I group (P = 0·046).
  
  
  CONCLUSIONS
  The choice of anastomotic reconstruction after distal gastrectomy resulted in no difference in long-term QoL in patients with gastric cancer.
  
  
  BACKGROUND
  NCT01065688 (http://www.clinicaltrials.gov).
authors: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors: M
authors: M
authors: Nakamura
authors: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors: M
authors: M
authors: Nakamori
authors: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors: T
authors: T
authors: Ojima
authors: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors: M
authors: M
authors: Iwahashi
authors: Department of Surgery, National Hospital Organization Osaka Minami Medical Centre, Osaka, Japan.
authors: T
authors: T
authors: Horiuchi
authors: Departments of Surgery, Labour Health and Welfare Organization Wakayama Rosai Hospital, Wakayama, Japan.
authors: Y
authors: Y
authors: Kobayashi
authors: Departments of Surgery, Shingu Municipal Medical Centre, Wakayama, Japan.
authors: N
authors: N
authors: Yamade
authors: Departments of Surgery, Hashimoto Municipal Hospital, Wakayama, Japan.
authors: K
authors: K
authors: Shimada
authors: Departments of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan.
authors: M
authors: M
authors: Oka
authors: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors: H
authors: H
authors: Yamaue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods* / Q000523:psychology; D005763:Gastroenterostomy / Q000379:methods* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D013274:Stomach Neoplasms / Q000523:psychology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult