Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Chin Med J (Engl). 2023 May 5;136(9):1074-1081. doi: 10.1097/CM9.0000000000002602.
The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer.
A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group ( N = 70) and R-Y group ( N = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied.
The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs . 88.8 ± 16.1, P = 0.033; postoperative 3 year: 87.3 ± 15.2 vs . 92.8 ± 11.3, P = 0.028; postoperative 5 year: 90.9 ± 13.7 vs . 96.4 ± 5.6, P = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs . 2.8 ± 5.3, P = 0.001; postoperative 5 year: 5.1 ± 9.8 vs . 1.8 ± 4.7, P = 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P = 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P = 0.006; postoperative 5 year: 6.0 ± 8.9 vs . 2.7 ± 4.6, P = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points.
Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes.
ChiCTR.org.cn, ChiCTR-TRC-10001434.
比较 Billroth-I（B-I）和 Roux-en-Y（R-Y）重建术对生活质量（QoL）影响的研究结果仍不一致。本试验旨在比较根治性远端胃癌切除术后 B-I 与 R-Y 吻合术的长期 QoL。
2011 年 5 月至 2014 年 5 月，四川大学华西医院对 140 例接受根治性远端胃切除术和 D2 淋巴结清扫术的患者进行了随机分组，B-I 组（n=70）和 R-Y 组（n=70）。随访时间点为术后 1、3、6、9、12、24、36、48 和 60 个月。最终随访时间为 2019 年 5 月。比较两组的临床病理特征、手术安全性、术后恢复、长期生存和生活质量，其中生活质量评分是主要结局。采用意向治疗分析。
两组的基线特征无统计学差异。两组术后发病率和死亡率以及术后恢复情况无统计学差异。B-I 组估计出血量较少，手术时间较短。两组 5 年总生存率（B-I 组 79%[55/70] vs. R-Y 组 80%[56/70]，P=0.966）和无复发生存率（B-I 组 79%[55/70] vs. R-Y 组 78%[55/70]，P=0.979）无统计学差异。R-Y 组的全球健康状况评分高于 B-I 组，差异有统计学意义（术后 1 年：85.4±13.1 vs. 88.8±16.1，P=0.033；术后 3 年：87.3±15.2 vs. 92.8±11.3，P=0.028；术后 5 年：90.9±13.7 vs. 96.4±5.6，P=0.010），反流（术后 3 年：8.8±12.9 vs. 2.8±5.3，P=0.001；术后 5 年：5.1±9.8 vs. 1.8±4.7，P=0.033）和上腹痛（术后 1 年：11.8±12.7 vs. 6.1±8.8，P=0.008；术后 3 年：9.4±10.6 vs. 4.6±7.9，P=0.006；术后 5 年：6.0±8.9 vs. 2.7±4.6，P=0.022）发生率低于 B-I 组。
与 B-I 组相比，R-Y 重建术可通过减少反流和上腹痛来改善长期 QoL，而不改变生存结局。
ChiCTR.org.cn，ChiCTR-TRC-10001434。
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