Anastomosis for Distal Gastrectomy in Chinese Patients: Uncut Roux-Y or Roux-Y?

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2020 Jan 11

PMID 31918683

Citations 3

Authors

B K Sah

J Li

C Yan

C Li

M Yan

Z G Zhu

Affiliations

Soon will be listed here.

Abstract

Background: An appropriate method of anastomosis is crucial for gastric cancer patients who require gastrojejunal anastomosis. Surgeons have proposed different types of modified gastrojejunostomies in the last two decades. We focused on two types of standard anastomosis, i.e., Uncut Roux-Y and Roux-Y gastrojejunostomies, and compared the differences in immediate postoperative complications between the two types.

Methods: This is a retrospective study on 236 gastric cancer patients who underwent curative distal gastrectomy with gastrojejunal Roux-Y or Uncut Roux-Y anastomosis for six consecutive years. Immediate postoperative complications were compared between the two groups. The authors discussed the causes of the significant complications and their management.

Results: There was no difference in demographics between the two groups (92 Roux-y Versus 144 Uncut Roux-y). The overall complication rate was 20.8% with 1.4% anastomotic leakage in the Uncut Roux-Y group versus 33.7% with 7.6% anastomotic failures in the Roux-Y group (p < 0.05). More abdominal infections occurred in the Roux-Y anastomosis group compared with the Uncut Roux-Y anastomosis group (p < 0.05). Duration of postoperative stay was significantly longer in patients with Roux-y anastomosis group (p < 0.05).

Conclusions: Considering the surgical simplicity and postoperative complications, the Uncut Roux-Y is a better choice for anastomosis in patients with gastric cancer undergoing gastrojejunostomy. A well-designed large cohort in a multi-centre randomized controlled trial is necessary to support these findings and compare other aspects.

Citing Articles

Uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.

Cai Z, Mu M, Ma Q, Liu C, Jiang Z, Liu B Cochrane Database Syst Rev. 2024; 2:CD015014.

PMID: 38421211 PMC: 10903295. DOI: 10.1002/14651858.CD015014.pub2.

To cut or not to cut? A prospective randomized controlled trial on short-term outcomes of the uncut Roux-en-Y reconstruction for gastric cancer.

Xu H, Yang L, Zhang D, Li Z, Li Q, Wang L Surg Endosc. 2023; 37(8):6172-6184.

PMID: 37160808 PMC: 10338403. DOI: 10.1007/s00464-023-10067-0.

Optimal Reconstruction After Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study.

Yan Y, Wang D, Liu Y, Lu L, Wang X, Zhao Z Cancer Control. 2022; 29:10732748221087059.

PMID: 35412845 PMC: 9121732. DOI: 10.1177/10732748221087059.

References

Huscher C, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A . Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005; 241(2):232-7. PMC: 1356907. DOI: 10.1097/01.sla.0000151892.35922.f2. View

Sun M, Fan Y, Dang S . Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis. World J Gastroenterol. 2018; 24(24):2628-2639. PMC: 6021772. DOI: 10.3748/wjg.v24.i24.2628. View

Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y . A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002; 131(1 Suppl):S306-11. DOI: 10.1067/msy.2002.120115. View

Song J, Oh S, Kang W, Hyung W, Choi S, Noh S . Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009; 249(6):927-32. DOI: 10.1097/01.sla.0000351688.64999.73. View

Hoya Y, Mitsumori N, Yanaga K . The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. Surg Today. 2009; 39(8):647-51. DOI: 10.1007/s00595-009-3964-2. View

Takiguchi S, Yamamoto K, Hirao M, Imamura H, Fujita J, Yano M . A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT. Gastric Cancer. 2011; 15(2):198-205. DOI: 10.1007/s10120-011-0098-1. View

Ma J, Zang L, Yang A, Hu W, Feng B, Dong F . A modified uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy: preliminary results and initial experience. Surg Endosc. 2017; 31(11):4749-4755. DOI: 10.1007/s00464-017-5551-8. View

Hirao M, Takiguchi S, Imamura H, Yamamoto K, Kurokawa Y, Fujita J . Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol. 2012; 20(5):1591-7. DOI: 10.1245/s10434-012-2704-9. View

Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J . Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. J Clin Oncol. 2016; 34(12):1350-7. DOI: 10.1200/JCO.2015.63.7215. View

10.

Noh S . Improvement of the Roux limb function using a new type of "uncut Roux" limb. Am J Surg. 2000; 180(1):37-40. DOI: 10.1016/s0002-9610(00)00421-9. View

11.

Sah B, Chen M, Yan M, Zhu Z . Gastric cancer surgery: Billroth I or Billroth II for distal gastrectomy?. BMC Cancer. 2009; 9:428. PMC: 2794879. DOI: 10.1186/1471-2407-9-428. View

12.

Tu B, Kelly K . Elimination of the Roux stasis syndrome using a new type of "uncut Roux" limb. Am J Surg. 1995; 170(4):381-6. DOI: 10.1016/s0002-9610(99)80308-0. View

13.

Uyama I, Sakurai Y, Komori Y, Nakamura Y, Syoji M, Tonomura S . Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer. Gastric Cancer. 2005; 8(4):253-7. DOI: 10.1007/s10120-005-0344-5. View

14.

Park Y, Shin D, Son S, Kim K, Park D, Ahn S . Roux Stasis Syndrome and Gastric Food Stasis After Laparoscopic Distal Gastrectomy with Uncut Roux-en-Y Reconstruction in Gastric Cancer Patients: A Propensity Score Matching Analysis. World J Surg. 2018; 42(12):4022-4032. DOI: 10.1007/s00268-018-4715-6. View

15.

Inokuchi M, Kojima K, Yamada H, Kato K, Hayashi M, Motoyama K . Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy. Gastric Cancer. 2012; 16(1):67-73. DOI: 10.1007/s10120-012-0154-5. View

16.

Imamura H, Takiguchi S, Yamamoto K, Hirao M, Fujita J, Miyashiro I . Morbidity and mortality results from a prospective randomized controlled trial comparing Billroth I and Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer. World J Surg. 2012; 36(3):632-7. DOI: 10.1007/s00268-011-1408-9. View

17.

Choi C, Baek D, Lee S, Hwang S, Kim D, Kim K . Comparison Between Billroth-II with Braun and Roux-en-Y Reconstruction After Laparoscopic Distal Gastrectomy. J Gastrointest Surg. 2016; 20(6):1083-90. DOI: 10.1007/s11605-016-3138-7. View

18.

Park J, Kim Y . Uncut Roux-en-Y Reconstruction after Laparoscopic Distal Gastrectomy Can Be a Favorable Method in Terms of Gastritis, Bile Reflux, and Gastric Residue. J Gastric Cancer. 2015; 14(4):229-37. PMC: 4286901. DOI: 10.5230/jgc.2014.14.4.229. View

19.

Vogel S, Drane W, WOODWARD E . Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy: prevention and treatment of alkaline reflux gastritis. An alternative to Roux-en-Y diversion. Ann Surg. 1994; 219(5):458-65; discussion 465-6. PMC: 1243168. DOI: 10.1097/00000658-199405000-00003. View

20.

Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D . Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002; 5(2):83-9. DOI: 10.1007/s101200200014. View