title: Roux-en-Y or Billroth II Reconstruction After Radical Distal Gastrectomy for Gastric Cancer: A Multicenter Randomized Controlled Trial.
abstract: The aim of the study was to compare the clinical symptoms between Billroth II (B-II) and Roux-en-Y (R-Y) reconstruction after distal subtotal gastrectomy (DG) for gastric cancer.
  
  
  
  Surgery is the mainstay of curative treatment for gastric cancer. The technique for reconstruction after DG remains controversial. Both B-II and R-Y are popular methods.
  
  
  
  This is a prospective multicenter randomized controlled trial. From October 2008 to October 2014, 162 patients who underwent DG were randomly allocated to B-II (n = 81) and R-Y (n = 81) groups. The primary endpoint is Gastrointestinal (GI) Symptoms Score 1 year after surgery. We also compared the nutritional status, extent of gastritis on endoscopy, and quality of life after surgery between the 2 procedures at 1 year.
  
  
  
  Operative time was significantly shorter for B-II than for R-Y [mean difference 21.5 minutes, 95% confidence interval (95% CI) 3.8-39.3, P = 0.019]. The B-II and R-Y groups had a peri-operative morbidity of 28.4% and 33.8%, respectively (P = 0.500) and a 30-day mortality of 2.5% and 1.2%, respectively (P = 0.500). GI symptoms score did not differ between R-Y versus B-II reconstruction (mean difference -0.45, 95% CI -1.21 to 0.31, P = 0.232). R-Y resulted in a lower median endoscopic grade for gastritis versus B-II (mean difference -1.32, 95% CI -1.67 to -0.98, P < 0.001). We noted no difference in nutritional status (R-Y versus B-II mean difference -0.31, 95% CI -3.27 to 2.65, P = 0.837) and quality of life at 1 year between the 2 groups too.
  
  
  
  Although BII is associated with a higher incidence of heartburn symptom and higher median endoscopic grade for gastritis, BII and RY are similar in terms of overall GI symptom score and nutritional status at 1 year after distal gastrectomy.
authors.affiliation: Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore.
authors.forename: Jimmy Bok-Yan
authors.initials: JB
authors.lastname: So
authors.affiliation: Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Jaideepraj
authors.initials: J
authors.lastname: Rao
authors.affiliation: Department of Surgery, Changi General Hospital, Singapore, Singapore.
authors.forename: Andrew Siang-Yih
authors.initials: AS
authors.lastname: Wong
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.affiliation: Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore.
authors.forename: Ning Qi
authors.initials: NQ
authors.lastname: Pang
authors.affiliation: Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore.
authors.forename: Amy Yuh Ling
authors.initials: AYL
authors.lastname: Tay
authors.affiliation: Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong.
authors.forename: Man Yee
authors.initials: MY
authors.lastname: Yung
authors.affiliation: Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Su
authors.affiliation: Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore.
authors.forename: Janelle Niam Sin
authors.initials: JNS
authors.lastname: Phua
authors.affiliation: Department of Surgery, National University Hospital, National University of Singapore, Singapore, Singapore.
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
authors.affiliation: Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong.
authors.forename: Enders Kwok Wai
authors.initials: EKW
authors.lastname: Ng
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D005763:Gastroenterostomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome