Roux‐en‐Y versus Billroth‐I reconstruction after surgery for | Figure 1

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Roux‐en‐Y versus Billroth‐I reconstruction after surgery for gastric cancer

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We reviewed the evidence for the effect of Roux‐en‐Y compared to Billroth‐I reconstruction after surgery for gastric cancer. We found eight studies.

Background

Gastric (stomach) cancer is one of the most common cancers worldwide. Recently, early detection rates of gastric cancer and treatment technology have improved. As a result, people can survive longer after surgery, and the importance of quality of life after surgery has been discussed. Billroth‐I and Roux‐en‐Y are both options for reconstruction of continuity of the gastrointestinal system after distal gastrectomy (removal of the lower part of the stomach).

However, there are no standards on which reconstructive procedure to select; guidelines do not describe which procedure should be a priority. It was therefore important to perform a review of the available evidence to aid decision making for people undergoing surgery, surgeons, physicians, medical staff, and policymakers.

Study characteristics

The evidence is current to 4 May 2021.

We identified eight trials including 942 participants with gastric cancer who underwent distal gastrectomy.

The evidence suggests that Roux‐en‐Y reconstruction may result in little to no difference in quality of life 12 months after surgery. However, these findings must be interpreted with caution because the study investigators measured quality of life in different ways. The evidence is very uncertain for the effect of the interventions on leakage through the reconstructed connection (anastomotic leakage).

Billroth‐I reconstruction may result in little to no difference in loss of body weight; probably increases bile reflux into the remnant stomach; and may reduce overall complications after surgery compared to Roux‐en‐Y reconstruction. The evidence is very uncertain for the effect of the procedures on length of hospital stay.

The certainty of the evidence for quality of life was low due to limitations in how the studies were designed and conducted, and because there are not enough studies to be certain about the results for this outcome. The certainty of the evidence for the other outcomes ranged from very low to moderate. Further research is needed to look at the effects over a longer time period.

Read the full Cochrane Review here:

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