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This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Randomized clinical trial comparing long‐term quality of life for Billroth I versus Roux‐en‐Y reconstruction after distal gastrectomy for gastric cancer. BJS 2016; 103: 337-347.

Published: 3rd February 2016

Authors: M. Nakamura, M. Nakamori, T. Ojima, M. Iwahashi, T. Horiuchi, Y. Kobayashi et al.

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.

Method

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).

Conclusion

The choice of anastomotic reconstruction after distal gastrectomy resulted in no difference in long‐term QoL in patients with gastric cancer. Registration number: NCT01065688 (http://www.clinicaltrials.gov).

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