Advancement of digestive tract reconstruction methods after distal gastrectomy for distal gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Zuocong , CUI Mingfu ,  SUN Libo

Department of Gastrointestinal Colorectal and Anal Surgery, China Japan Union Hospital, Jilin University, Changchun 130033, P.R.China;

Corresponding author：

SUN Libo, Email: sunlibo0431@sina.com

Keywords：

gastric cancer; distal gastrectomy; digestive tract reconstruction

DOI：

10.7507/1007-9424.201702002

Video：

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Objective To summarize recent progress of three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer. Methods Recent domestic and international literatures about three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer were collected and analyzed. Results Of the three types of basic digestive tract reconstruction methods, BillrothⅠanastomosis had the most obvious advantage compared to BillrothⅡanastomosis and Roux-en Y anastomosis, but it was limited by tumor' size. The performance of BillrothⅡanastomosis was relatively easier but its complication risk was higher. Roux-en-Y anastomosis was superior in body weight control and treatment of type 2 diabetes mellitus, and had a wider indication than the other two types of methods. The modified uncut Roux-en-Y anastomosis was easier to perform under laparoscopic surgery. Conclusions Each method of the three types of basic digestive tract reconstruction methods after distal gastrectomy has its own superiority and indication. Therefore, the choice of digestive tract reconstruction method after distal gastrectomy should be case by case.

Citation： ZHANG Zuocong, CUI Mingfu, SUN Libo. Advancement of digestive tract reconstruction methods after distal gastrectomy for distal gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 775-778. doi: 10.7507/1007-9424.201702002 Copy

1.	Misawa K, Terashima M, Uenosono Y, et al. Evaluation of postgastrectomy symptoms after distal gastrectomy with Billroth-Ⅰreconstruction using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Gastric Cancer, 2015, 18(3): 675-681.
2.	Terashima M, Tanabe K, Yoshida M, et al. Postgastrectomy Syndrome Assessment Scale (PGSAS)-45 and changes in body weight are useful tools for evaluation of reconstruction methods following distal gastrectomy. Ann Surg Oncol, 2014, 21 Suppl 3: S370-S378.
3.	Imamura T, Komatsu S, Ichikawa D, et al. Reconstruction method as an independent risk factor for the postoperative decrease in hemoglobin in stageⅠgastric cancer. J Gastroenterol Hepatol, 2016, 31(5): 959-864.
4.	Kumagai K, Shimizu K, Yokoyama N, et al. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today, 2012, 42(5): 411-418.
5.	Fujita J, Takahashi M, Urushihara T, et al. Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-Ⅰdistal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study. Gastric Cancer, 2016, 19(1): 302-311.
6.	Kwon Y, Jung Kim H, Lo Menzo E, et al. A systematic review and meta-analysis of the effect of Billroth reconstruction on type 2 diabetes: a new perspective on old surgical methods. Surg Obes Relat Dis, 2015, 11(6): 1386-1395.
7.	Nakamura M, Nakamori M, Ojima T, et al. Randomized clinical trial comparing long-term quality of life for BillrothⅠ versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg, 2016, 103(4): 337-347.
8.	Tanizawa Y, Bando E, Kawamura T, et al. Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer. Gastric Cancer, 2010, 13(1): 50-57.
9.	Ishikawa M, Kitayama J, Kaizaki S, et al. Prospective randomized trial comparing BillrothⅠand Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg, 2005, 29(11): 1415-1420.
10.	Kojima K, Yamada H, Inokuchi M, et al. A comparison of Roux-en-Y and Billroth-Ⅰreconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg, 2008, 247(6): 962-967.
11.	Nomura E, Lee SW, Bouras G, et al. Functional outcomes according to the size of the gastric remnant and type of reconstruction following laparoscopic distal gastrectomy for gastric cancer. Gastric Cancer, 2011, 14(3): 279-284.
12.	刘震, 刘书尚, 徐光辉, 等. 远端胃癌患者毕Ⅰ式与毕Ⅱ式吻合术后并发症及远期生存比较. 中华胃肠外科杂志, 2016, 19(7): 785-788.
13.	Huang C, Lin M, Chen Q, et al. A modified intracorporeal Billroth-Ⅰanastomosis after laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique. Ann Surg Oncol, 2015, 22(1): 247.
14.	Omori T, Masuzawa T, Akamatsu H, et al. A simple and safe method for BillrothⅠreconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg, 2014, 18(3): 613-616.
15.	Tran TB, Worhunsky DJ, Squires MH, et al. To Roux or not to Roux: a comparison between Roux-en-Y and BillrothⅡreconstruction following partial gastrectomy for gastric cancer. Gastric Cancer, 2016, 19(3): 994-1001.
16.	Haverkamp L, Ruurda JP, Offerhaus GJ, et al. Laparoscopic gastrectomy in Western European patients with advanced gastric cancer. Eur J Surg Oncol, 2016, 42(1): 110-115.
17.	胡祥. 远端胃癌术后的消化道重建. 中华胃肠外科杂志, 2014, 17(5): 419-423.
18.	In Choi C, Baek DH, Lee SH, et al. Comparison between Billroth-Ⅱwith Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. J Gastrointest Surg, 2016, 20(6): 1083-1090.
19.	Kim CH, Song KY, Park CH, et al. A comparison of outcomes of three reconstruction methods after laparoscopic distal gastrectomy. J Gastric Cancer, 2015, 15(1): 46-52.
20.	Kang KC, Cho GS, Han SU, et al. Comparison of BillrothⅠand BillrothⅡreconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc, 2011, 25(6): 1953-1961.
21.	Sah BK, Chen MM, Yan M, et al. Gastric cancer surgery: BillrothⅠor BillrothⅡfor distal gastrectomy? BMC Cancer, 2009, 9(12): 428.
22.	Kim DJ, Lee JH, Kim W. Afferent loop obstruction following laparoscopic distal gastrectomy with Billroth-Ⅱgastrojejunostomy. J Korean Surg Soc, 2013, 84(5): 281-286.
23.	Vogel SB, Drane WE, Woodward ER. 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): 458-465.
24.	Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg, 2004, 91(5): 528-539.
25.	Basso N, Materia A, Gizzonio D, et al. Nutritional effects of total gastrectomy. A prospective randomized study of Roux-en-Y vs Longmire-Mouchet reconstruction. Ital J Surg Sci, 1985, 15(4): 335-340.
26.	Shinoto K, Ochiai T, Suzuki T, et al. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today, 2003, 33(3): 159-177.
27.	Xiong JJ, Altaf K, Javed MA, et al. Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol, 2013, 19(7): 1124-1134.
28.	Namikawa T, Kitagawa H, Okabayashi T, et al. Roux-en-Y reconstruction is superior to BillrothⅠreconstruction in reducing reflux esophagitis after distal gastrectomy: special relationship with the angle of his. World J Surg, 2010, 34(5): 1022-1027.
29.	Zhu Z, Shan X, Cheng Y, et al. Clinical course of diabetes after gastrectomy according to type of reconstruction in patients with concurrent gastric cancer and type 2 diabetes. Obes Surg, 2015, 25(4): 673-679.
30.	Park JY, Kim YJ. 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, 2014, 14(4): 229-237.
31.	Imamura H, Takiguchi S, Yamamoto K, et al. Morbidity and mortality results from a prospective randomized controlled trial comparing BillrothⅠand Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer. World J Surg, 2012, 36(3): 632-637.
32.	Uyama I, Sakurai Y, Komori Y, et al. Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer. Gastric Cancer, 2005, 8(4): 253-257.
33.	李昉璇, 张汝鹏, 赵敬柱, 等. 非离断式 Roux-en-Y 吻合在远端胃癌根治术后消化道重建中的应用. 中华胃肠外科杂志, 2011, 14(6): 411-414.
34.	Mon RA, Cullen JJ. Standard Roux-en-Y gastrojejunostomy vs. ‘uncut’ Roux-en-Y gastrojejunostomy: a matched cohort study. J Gastrointest Surg, 2000, 4(3): 298-303.

1. Misawa K, Terashima M, Uenosono Y, et al. Evaluation of postgastrectomy symptoms after distal gastrectomy with Billroth-Ⅰreconstruction using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Gastric Cancer, 2015, 18(3): 675-681.
2. Terashima M, Tanabe K, Yoshida M, et al. Postgastrectomy Syndrome Assessment Scale (PGSAS)-45 and changes in body weight are useful tools for evaluation of reconstruction methods following distal gastrectomy. Ann Surg Oncol, 2014, 21 Suppl 3: S370-S378.
3. Imamura T, Komatsu S, Ichikawa D, et al. Reconstruction method as an independent risk factor for the postoperative decrease in hemoglobin in stageⅠgastric cancer. J Gastroenterol Hepatol, 2016, 31(5): 959-864.
4. Kumagai K, Shimizu K, Yokoyama N, et al. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today, 2012, 42(5): 411-418.
5. Fujita J, Takahashi M, Urushihara T, et al. Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-Ⅰdistal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study. Gastric Cancer, 2016, 19(1): 302-311.
6. Kwon Y, Jung Kim H, Lo Menzo E, et al. A systematic review and meta-analysis of the effect of Billroth reconstruction on type 2 diabetes: a new perspective on old surgical methods. Surg Obes Relat Dis, 2015, 11(6): 1386-1395.
7. Nakamura M, Nakamori M, Ojima T, et al. Randomized clinical trial comparing long-term quality of life for BillrothⅠ versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg, 2016, 103(4): 337-347.
8. Tanizawa Y, Bando E, Kawamura T, et al. Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer. Gastric Cancer, 2010, 13(1): 50-57.
9. Ishikawa M, Kitayama J, Kaizaki S, et al. Prospective randomized trial comparing BillrothⅠand Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg, 2005, 29(11): 1415-1420.
10. Kojima K, Yamada H, Inokuchi M, et al. A comparison of Roux-en-Y and Billroth-Ⅰreconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg, 2008, 247(6): 962-967.
11. Nomura E, Lee SW, Bouras G, et al. Functional outcomes according to the size of the gastric remnant and type of reconstruction following laparoscopic distal gastrectomy for gastric cancer. Gastric Cancer, 2011, 14(3): 279-284.
12. 刘震, 刘书尚, 徐光辉, 等. 远端胃癌患者毕Ⅰ式与毕Ⅱ式吻合术后并发症及远期生存比较. 中华胃肠外科杂志, 2016, 19(7): 785-788.
13. Huang C, Lin M, Chen Q, et al. A modified intracorporeal Billroth-Ⅰanastomosis after laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique. Ann Surg Oncol, 2015, 22(1): 247.
14. Omori T, Masuzawa T, Akamatsu H, et al. A simple and safe method for BillrothⅠreconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg, 2014, 18(3): 613-616.
15. Tran TB, Worhunsky DJ, Squires MH, et al. To Roux or not to Roux: a comparison between Roux-en-Y and BillrothⅡreconstruction following partial gastrectomy for gastric cancer. Gastric Cancer, 2016, 19(3): 994-1001.
16. Haverkamp L, Ruurda JP, Offerhaus GJ, et al. Laparoscopic gastrectomy in Western European patients with advanced gastric cancer. Eur J Surg Oncol, 2016, 42(1): 110-115.
17. 胡祥. 远端胃癌术后的消化道重建. 中华胃肠外科杂志, 2014, 17(5): 419-423.
18. In Choi C, Baek DH, Lee SH, et al. Comparison between Billroth-Ⅱwith Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. J Gastrointest Surg, 2016, 20(6): 1083-1090.
19. Kim CH, Song KY, Park CH, et al. A comparison of outcomes of three reconstruction methods after laparoscopic distal gastrectomy. J Gastric Cancer, 2015, 15(1): 46-52.
20. Kang KC, Cho GS, Han SU, et al. Comparison of BillrothⅠand BillrothⅡreconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc, 2011, 25(6): 1953-1961.
21. Sah BK, Chen MM, Yan M, et al. Gastric cancer surgery: BillrothⅠor BillrothⅡfor distal gastrectomy? BMC Cancer, 2009, 9(12): 428.
22. Kim DJ, Lee JH, Kim W. Afferent loop obstruction following laparoscopic distal gastrectomy with Billroth-Ⅱgastrojejunostomy. J Korean Surg Soc, 2013, 84(5): 281-286.
23. Vogel SB, Drane WE, Woodward ER. 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): 458-465.
24. Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg, 2004, 91(5): 528-539.
25. Basso N, Materia A, Gizzonio D, et al. Nutritional effects of total gastrectomy. A prospective randomized study of Roux-en-Y vs Longmire-Mouchet reconstruction. Ital J Surg Sci, 1985, 15(4): 335-340.
26. Shinoto K, Ochiai T, Suzuki T, et al. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today, 2003, 33(3): 159-177.
27. Xiong JJ, Altaf K, Javed MA, et al. Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol, 2013, 19(7): 1124-1134.
28. Namikawa T, Kitagawa H, Okabayashi T, et al. Roux-en-Y reconstruction is superior to BillrothⅠreconstruction in reducing reflux esophagitis after distal gastrectomy: special relationship with the angle of his. World J Surg, 2010, 34(5): 1022-1027.
29. Zhu Z, Shan X, Cheng Y, et al. Clinical course of diabetes after gastrectomy according to type of reconstruction in patients with concurrent gastric cancer and type 2 diabetes. Obes Surg, 2015, 25(4): 673-679.
30. Park JY, Kim YJ. 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, 2014, 14(4): 229-237.
31. Imamura H, Takiguchi S, Yamamoto K, et al. Morbidity and mortality results from a prospective randomized controlled trial comparing BillrothⅠand Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer. World J Surg, 2012, 36(3): 632-637.
32. Uyama I, Sakurai Y, Komori Y, et al. Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer. Gastric Cancer, 2005, 8(4): 253-257.
33. 李昉璇, 张汝鹏, 赵敬柱, 等. 非离断式 Roux-en-Y 吻合在远端胃癌根治术后消化道重建中的应用. 中华胃肠外科杂志, 2011, 14(6): 411-414.
34. Mon RA, Cullen JJ. Standard Roux-en-Y gastrojejunostomy vs. ‘uncut’ Roux-en-Y gastrojejunostomy: a matched cohort study. J Gastrointest Surg, 2000, 4(3): 298-303.

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Advancement of digestive tract reconstruction methods after distal gastrectomy for distal gastric cancer

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