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Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 databaseopen access

Authors
Park, Shin-HooHur, HoonPark, Jong-HyunLee, Chang-MinSon, Young-GilJung, Mi RanLee, Han HongHwang, Sun-HwiLee, Moon-SooSeo, Sang HyukJeong, In HoSon, Myoung WonKim, Chang HyunYoo, Moon-WonOh, Sung JinHwang, Seong HoIl Choi, SungChoi, Hyuk SoonKeum, Bo-RaYang, Kyung SookPark, Sungsoo
Issue Date
Jan-2024
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Keywords
bile reflux; Billroth II; Braun; gastric cancer; quality of life; Roux-en-Y
Citation
International Journal of Surgery, v.110, no.1, pp 32 - 44
Pages
13
Indexed
SCIE
Journal Title
International Journal of Surgery
Volume
110
Number
1
Start Page
32
End Page
44
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/65433
DOI
10.1097/JS9.0000000000000796
ISSN
1743-9191
1743-9159
Abstract
Backgrounds: This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG).Materials and methods: We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups.Results: In endoscopic findings, bile reflux was the lowest in the RY group (n=67), followed by the BII-B (n=183) and BII groups (n=147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P<0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups.Conclusions: BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.
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Lee, Chang Min
Ansan Hospital (Department of Foregut Surgery, Ansan Hospital)
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