Prospective randomized trial comparing Billroth I and Billroth II procedures for carcinoma of the gastric antrum

Controversy persists regarding digestive reconnection following subtotal gastrectomy for carcinoma. A randomized prospective trial comparing Billroth I and Billroth II procedures for mortality, digestive comfort, survival, and patterns of recurrence was conducted.

Thirty patients underwent Billroth I and 32 patients underwent Billroth II procedures. Stages I, II, III, and IV of the tumor-node-metastasis (TNM) staging system accounted for 27, 16, 47, and 10 percent of tumors, respectively. Billroth I and II groups were well-matched for clinicopathologic variables.

Duration of surgery, volume of blood transfused, and abdominal drainage were similar in the two groups. The duration and volume of gastric drainage were greater in patients following Billroth I procedures. Four fistulas were noted in the Billroth I group and one fistula developed in a patient following Billroth II gastrectomy. Billroth I gastrectomy and low preoperative serum albumin were independent risk factors for fistula development. Fistula development accounted for an increase in the duration of hospital stay following Billroth I procedures. Hospital mortality was similar in the two groups. Five-year actuarial survival rate was 42 and 40 percent for patients undergoing Billroth I and Billroth II procedures, respectively. Long-term survival was similar for patients having each procedure, and this was verified for all TNM stages. There were seven recurrences at the hepatic pedicle in the Billroth I group and one recurrence of this type in the Billroth II group, requiring four reinterventions.

Digestive comfort and long-term survival are similar after Billroth I and Billroth II gastrectomy for carcinoma. Billroth I gastrectomy is associated with an increased risk of fistula development and of recurrence of carcinoma at the hepatic pedicle.