Reconstruction After Distal Gastrectomy for Gastric Cancer: Billroth 2 or Roux-En-Y Procedure?

Distal gastrectomy (DG) represents the only curative treatment for most mid-lower gastric cancers (GCs). As of 2017, however, no reconstructive modality to conduct after DG has gained unanimous consensus. Additionally, most authors have investigated Billroth 1 and Roux-en-Y (RY) rather than Billroth 2 (B2) reconstruction. We analyzed B2 and RY gastrojejunostomy to identify the preferable technique and augment the available information on B2 restoration.

We retrospectively selected 132 GC patients who were consecutively submitted to DG at our institution between April 2005 and February 2016. B2 and RY anastomosis were accomplished as methods of reconstruction (respectively 36 and 96 cases). We compared these techniques in terms of clinicopathological, surgical, postoperative and oncologic outcomes.

Compared to RY gastrojejunostomy, B2 reconstruction was significantly associated with a greater mean number of harvested lymph nodes (26.03 vs. 21.65, p=0.045) but also with a longer hospital stay (22.8 vs. 15.7 days) (p=0.022) and higher readmission rate (28.57% vs. 3.1%, p<0.0001). On multivariate analysis, reconstruction method was the most significant independent prognostic factor for hospital readmission.

In light of our results, we propose that B2 gastrojejunostomy deserves more study in order to better identify the best post-DG anastomosis.