Randomized Controlled Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2017; 23(34): 6350-6356
Published online Sep 14, 2017. doi: 10.3748/wjg.v23.i34.6350
Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?
Dong Yang, Liang He, Wei-Hua Tong, Zhi-Fang Jia, Tong-Rong Su, Quan Wang
Dong Yang, Liang He, Wei-Hua Tong, Tong-Rong Su, Quan Wang, Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Zhi-Fang Jia, Division of Clinical Research, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Yang D and Wang Q designed the research; Yang D, He L and Wang Q performed the research; Yang D, Tong WH and Su TR collected the clinical data; Yang D and Jia ZF analyzed the data; Yang D, He L and Wang Q wrote the paper.
Institutional review board statement: This study was evaluated and approved by the ethics committee at our institution.
Clinical trial registration statement: This study is registered at clinicaltrials.gov. The registration identification number is NCT02694081.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at 18844097668@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Quan Wang, PhD, Professor, Surgeon, Department of Gastrointestinal and Anal Surgery, the First Hospital of Jilin University, No. 71, Xinmin Street, Changchun 130021, Jilin Province, China. wquan@jlu.edu.cn
Telephone: +86-431-81875602 Fax: +86-431-81875602
Received: June 6, 2017
Peer-review started: June 18, 2017
First decision: June 26, 2017
Revised: July 8, 2017
Accepted: August 8, 2017
Article in press: August 8, 2017
Published online: September 14, 2017
Abstract
AIM

To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth II reconstruction.

METHODS

A total of 158 patients who underwent laparoscopy-assisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University (Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y (group U) and Billroth II group (group B). Postoperative complications and relevant clinical data were compared between the two groups.

RESULTS

According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B (7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach pH values were lower than 7 and group B pH values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis (P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%.

CONCLUSION

Compared with Billroth II reconstruction, uncut Roux-en-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.

Keywords: Gastric cancer, Uncut Roux-en-Y, Billroth II, Bile reflux, Alkaline gastritis

Core tip: Because of the challenge of recanalization, the uncut Roux-en-Y reconstruction is still controversial and needs further study. This study is the first randomized controlled trial concentrating on uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer. This study aimed to compare uncut Roux-en-Y and Billroth II reconstruction in terms of postoperative complications, including biliary reflux and gastritis. Despite the incidence of recanalization, uncut Roux-en-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn.