BILLROTH-I RECONSTRUCTION IN DISTAL SUBTOTAL GASTRECTOMY FOR NON-EARLY, NON-METASTATIC GASTRIC ADENOCARCINOMA

Billroth-I anastomosis in distal gastrectomy for cancer

Abstract

BACKGROUND: Billroth-I (B-I) technique is known as a simple and physiological reconstruction method after distal subtotal gastrectomy for early gastric cancer. Yet its role and oncological validity in non-early gastric adenocarcinoma (NEGA) remain unclear.

METHODS: Patients with NEGA without distant metastases operated between May 2004 and December 2020 were included. Surgical and oncologic outcomes of distal subtotal gastrectomy with B-I reconstruction were compared to those with Billroth II (B-II) reconstruction. Propensity score matching (PSM) was used to adjust for age, gender, tumor size, location, resection type, pT and pN stages.

RESULTS: A total number of 332 patients undertwent distal subtotal gastrectomy for NEGA followed by B-I and B-II reconstructions in 165 (49.7%) and 167 (50.3%) cases, respectively. The use of B-I was associated with smaller tumor size, less advanced pT stage, tumor location in the gastric antrum and lower proporiton of multiorgan resections. These differences became statistically non-significant after applying PSM. Despite that, B-I remained associated with shorter operative time and greater lymph node yield. Other postoperative and short-term oncologic outcomes were similar. The use of B-I was associated with lower recurrence, specifically local recurrence. This association was not significant in the multivariable model. Median survival was 38 months, while 3- and 5-year survival rates were 52 and 32%, respectively. No differences were seen between the groups.

CONCLUSION: The use of B-I reconstruction in distal subtotal gastrectomy for NEGA is associated with satisfactory surgical and oncologic outcomes. Thus, it should be considered as a valid option in these patients.