Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan.
Gastric Cancer. 2020 Jul;23(4):734-745. doi: 10.1007/s10120-020-01048-6. Epub 2020 Feb 17.
Few well-controlled studies have compared postoperative complications between Billroth I (B-I) and Roux-en-Y (R-Y). The aim of the present study was to compare the incidence of overall and severe postoperative complications by reconstruction method after distal gastrectomy.
We performed a multi-institutional dataset study of patients who underwent distal gastrectomy with B-I or R-Y reconstruction from 2010 to 2014. Using propensity scores to strictly balance the significant variables, we compared postoperative complications between the techniques.
After matching, we enrolled 1014 patients (n = 507 in each group). The incidence of postoperative complications in the R-Y group was significantly higher vs the B-I group (29% vs 17%, P < 0.0001). The incidence of intra-abdominal abscess (4.3% vs 1.8%, P = 0.0177), bowel obstruction (2.6% vs 0.6%, P = 0.0203), and delayed gastric emptying (5.3% vs 1.0%, P < 0.0001) in the R-Y group was significantly higher vs the B-I group, respectively; we saw no significant difference in leakage (3.4% vs 4.1%, P = 0.5084). The incidence of grade ≥ III severe postoperative complications in the R-Y group was significantly higher vs the B-I group (13% vs 7.1%, P = 0.0013). Multivariable analysis showed that R-Y reconstruction was a strong independent risk factor for overall postoperative complications (odds ratio 1.58, P = 0.0044) and grade ≥ III severe postoperative complications (odds ratio 1.75, P = 0.0127). A forest plot revealed that R-Y reconstruction was associated with a greater risk of both overall and grade ≥ III severe postoperative complications in any subgroups.
R-Y reconstruction was associated with increasing overall postoperative complications, as well as severe postoperative complications.
很少有对照良好的研究比较 Billroth I（B-I）和 Roux-en-Y（R-Y）术后并发症。本研究旨在比较远端胃切除术后不同重建方法的总体和严重术后并发症的发生率。
我们对 2010 年至 2014 年接受 B-I 或 R-Y 重建的远端胃切除术患者进行了多机构数据集研究。使用倾向评分严格平衡显著变量，比较了两种技术之间的术后并发症。
匹配后，我们纳入了 1014 例患者（每组 507 例）。R-Y 组术后并发症的发生率明显高于 B-I 组（29%比 17%，P<0.0001）。R-Y 组的腹腔脓肿（4.3%比 1.8%，P=0.0177）、肠梗阻（2.6%比 0.6%，P=0.0203）和胃排空延迟（5.3%比 1.0%，P<0.0001）的发生率明显高于 B-I 组，两组之间漏液的发生率（3.4%比 4.1%，P=0.5084）无显著差异。R-Y 组中≥III 级严重术后并发症的发生率明显高于 B-I 组（13%比 7.1%，P=0.0013）。多变量分析显示，R-Y 重建是总术后并发症（优势比 1.58，P=0.0044）和≥III 级严重术后并发症（优势比 1.75，P=0.0127）的独立危险因素。森林图显示，R-Y 重建与任何亚组的总术后并发症和≥III 级严重术后并发症的风险增加均相关。
R-Y 重建与总术后并发症以及严重术后并发症的增加相关。
