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Erschienen in: Gastric Cancer 2/2012

01.04.2012 | Original article

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

verfasst von: Shuji Takiguchi, Kazuyoshi Yamamoto, Motohiro Hirao, Hiroshi Imamura, Junya Fujita, Masahiko Yano, Kenji Kobayashi, Yutaka Kimura, Yukinori Kurokawa, Masaki Mori, Yuichiro Doki, Osaka University Clinical Research Group for Gastroenterological Study

Erschienen in: Gastric Cancer | Ausgabe 2/2012

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Abstract

Background

Both Billroth I (B-I) and Roux-en-Y (R-Y) reconstructions are commonly performed as standard procedures, but it has yet to be determined which reconstruction is better for patients. A randomized prospective phase II trial with body weight loss at 1 year after surgery as a primary endpoint was performed to address this issue. The current report delivers data on the quality of life and degree of postoperative dysfunction, which were the secondary endpoints of this study.

Methods

Gastric cancer patients who underwent distal gastrectomy were intraoperatively randomized to B-I or R-Y. Postsurgical QOL was evaluated using the EORTC QLQ-C30 and DAUGS 20.

Results

Between August 2005 and December 2008, 332 patients were enrolled in a randomized trial comparing B-I versus R-Y. A mail survey questionnaire sent to 327 patients was completed by 268 (86.2%) of them. EORTC QLQ-C30 scores were as follows: global health status was similar in each group (B-I 73.5 ± 18.8, R-Y 73.2 ± 20.2, p = 0.87). Scores of five functional scales were also similar. Only the dyspnea symptom scale showed superior results for R-Y than for B-I (B-I 13.6 ± 17.9, R-Y 8.6 ± 16.3, p = 0.02). With respect to DAUGS 20, the total score did not differ significantly between the R-Y and B-I groups (24.8 vs. 23.6, p = 0.41). Only reflux symptoms were significantly worse for B-I than for R-Y (0.7 ± 0.6 vs. 0.5 ± 0.6, p = 0.01).

Conclusions

The B-I and R-Y techniques were generally equivalent in terms of postoperative QOL and dysfunction. Both procedures seem acceptable as standard reconstructions after distal gastrectomy with regard to postoperative QOL and dysfunction.
Literatur
1.
Zurück zum Zitat Yoshino K. History of gastric cancer surgery. J Jpn Surg Soc. 2000;101:855–60. Yoshino K. History of gastric cancer surgery. J Jpn Surg Soc. 2000;101:855–60.
2.
Zurück zum Zitat Weil PH, Buchberger R. From Billroth to PCV: a century of gastric surgery. World J Surg. 1999;23:736–42.PubMedCrossRef Weil PH, Buchberger R. From Billroth to PCV: a century of gastric surgery. World J Surg. 1999;23:736–42.PubMedCrossRef
3.
Zurück zum Zitat Osugi H, Fukuhara K, Tagada N, et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology. 2004;51:1215–8.PubMed Osugi H, Fukuhara K, Tagada N, et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology. 2004;51:1215–8.PubMed
4.
Zurück zum Zitat Kauer WK, Peters JH, DeMeester TR, et al. Composition and concentration of bile acids reflux into the esophagus of patients with gastroesophageal reflux disease. Surgery. 1997;122:874–81.PubMedCrossRef Kauer WK, Peters JH, DeMeester TR, et al. Composition and concentration of bile acids reflux into the esophagus of patients with gastroesophageal reflux disease. Surgery. 1997;122:874–81.PubMedCrossRef
5.
Zurück zum Zitat Svensson JO. Duodenogastric reflux after gastric surgery. Scand J Gastroenterol. 1983;18:729–34.PubMedCrossRef Svensson JO. Duodenogastric reflux after gastric surgery. Scand J Gastroenterol. 1983;18:729–34.PubMedCrossRef
6.
Zurück zum Zitat Fein M, Peters JH, Chandrasoma P, et al. Duodenoesophageal reflux induces esophageal adenocarcinoma without exogenous carcinogen. J Gastrointest Surg. 1998;2:260–8.PubMedCrossRef Fein M, Peters JH, Chandrasoma P, et al. Duodenoesophageal reflux induces esophageal adenocarcinoma without exogenous carcinogen. J Gastrointest Surg. 1998;2:260–8.PubMedCrossRef
7.
Zurück zum Zitat Taylor PR, Mason RC, Filipe MI, et al. Gastric carcinogenesis in the rat induced by duodenogastric reflux without carcinogens, morphology, mucin histochemistry, polyamine metabolism, and labeling index. Gut. 1991;32:1447–54.PubMedCrossRef Taylor PR, Mason RC, Filipe MI, et al. Gastric carcinogenesis in the rat induced by duodenogastric reflux without carcinogens, morphology, mucin histochemistry, polyamine metabolism, and labeling index. Gut. 1991;32:1447–54.PubMedCrossRef
8.
Zurück zum Zitat Sato T, Miwa K, Sahara H. The sequential model of Barrett’s esophagus and adenocarcinoma induced by duodeno-esophageal reflux without exogenous carcinogens. Anticancer Res. 2002;22:39–44.PubMed Sato T, Miwa K, Sahara H. The sequential model of Barrett’s esophagus and adenocarcinoma induced by duodeno-esophageal reflux without exogenous carcinogens. Anticancer Res. 2002;22:39–44.PubMed
9.
Zurück zum Zitat Mackman S, Lemmer KE, Morrissey JF. Postoperative reflux alkali gastritis and esophagitis. Am J Surg. 1971;121:694–7.PubMedCrossRef Mackman S, Lemmer KE, Morrissey JF. Postoperative reflux alkali gastritis and esophagitis. Am J Surg. 1971;121:694–7.PubMedCrossRef
10.
Zurück zum Zitat Gillison EW, Kusakari K, Bombeck CT, et al. The importance of bile in reflux oesophagitis and the success in its prevention by surgical means. Br J Surg. 1972;59:794–8.PubMedCrossRef Gillison EW, Kusakari K, Bombeck CT, et al. The importance of bile in reflux oesophagitis and the success in its prevention by surgical means. Br J Surg. 1972;59:794–8.PubMedCrossRef
11.
Zurück zum Zitat Mathias JR, Fernandez A, Sninsky CA, et al. Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: motility of the jejuna limb. Gastroenterology. 1985;88:101–7.PubMed Mathias JR, Fernandez A, Sninsky CA, et al. Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: motility of the jejuna limb. Gastroenterology. 1985;88:101–7.PubMed
12.
Zurück zum Zitat Ishikawa M, Kitayama J, Kaizaki S, et al. Prospective randomized trial comparing Billroth-I and Roux-en-Y procedures after distal gastrectomy for gastric cancer. World J Surg. 2005;29:1415–20.PubMedCrossRef Ishikawa M, Kitayama J, Kaizaki S, et al. Prospective randomized trial comparing Billroth-I and Roux-en-Y procedures after distal gastrectomy for gastric cancer. World J Surg. 2005;29:1415–20.PubMedCrossRef
13.
Zurück zum Zitat Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1:10–24.PubMedCrossRef Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1:10–24.PubMedCrossRef
14.
Zurück zum Zitat Kobayashi K, Takeda F, Teramukai S, et al. A cross-validation of the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30) for Japanese with lung cancer. Eur J Cancer. 1998;34:810–5.PubMedCrossRef Kobayashi K, Takeda F, Teramukai S, et al. A cross-validation of the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30) for Japanese with lung cancer. Eur J Cancer. 1998;34:810–5.PubMedCrossRef
15.
Zurück zum Zitat Wu C, Chiou J, Ko F, et al. Quality of life after curative gastrectomy for gastric cancer in a randomized controlled trial. Br J Cancer. 2008;98:54–9.PubMedCrossRef Wu C, Chiou J, Ko F, et al. Quality of life after curative gastrectomy for gastric cancer in a randomized controlled trial. Br J Cancer. 2008;98:54–9.PubMedCrossRef
16.
Zurück zum Zitat Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQC30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.PubMedCrossRef Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQC30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.PubMedCrossRef
17.
Zurück zum Zitat Nakamura M, Kido Y, Yano M, Hosoya Y. Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma. Surg Today. 2005;35:535–42.PubMedCrossRef Nakamura M, Kido Y, Yano M, Hosoya Y. Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma. Surg Today. 2005;35:535–42.PubMedCrossRef
18.
Zurück zum Zitat Nakamura M, Hosoya Y, Yano M, Doki Y, Miyashiro I, Kurashina K, Morooka Y, Kishi K, Lefor AT. Extent of gastric resection impacts patient quality of life: the Dysfunction after Upper Gastrointestinal Surgery for Cancer (DAUGS32) Scoring System. Ann Surg Oncol. 2011;18:314–20.PubMedCrossRef Nakamura M, Hosoya Y, Yano M, Doki Y, Miyashiro I, Kurashina K, Morooka Y, Kishi K, Lefor AT. Extent of gastric resection impacts patient quality of life: the Dysfunction after Upper Gastrointestinal Surgery for Cancer (DAUGS32) Scoring System. Ann Surg Oncol. 2011;18:314–20.PubMedCrossRef
19.
Zurück zum Zitat Kim YW, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.PubMedCrossRef Kim YW, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.PubMedCrossRef
20.
Zurück zum Zitat Kobayashi D, Kodera Y, Fujiwara M, Koike M, Nakayama G, Nakao A. Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World J Surg. 2011;35:357–64.PubMedCrossRef Kobayashi D, Kodera Y, Fujiwara M, Koike M, Nakayama G, Nakao A. Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World J Surg. 2011;35:357–64.PubMedCrossRef
21.
Zurück zum Zitat Shibata Y. Effect of semifundoplication with subtotal gastrectomy for prevention of postoperative gastroesophageal reflux. J Am Coll Surg. 2004;198:212–7.PubMedCrossRef Shibata Y. Effect of semifundoplication with subtotal gastrectomy for prevention of postoperative gastroesophageal reflux. J Am Coll Surg. 2004;198:212–7.PubMedCrossRef
Metadaten
Titel
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
verfasst von
Shuji Takiguchi
Kazuyoshi Yamamoto
Motohiro Hirao
Hiroshi Imamura
Junya Fujita
Masahiko Yano
Kenji Kobayashi
Yutaka Kimura
Yukinori Kurokawa
Masaki Mori
Yuichiro Doki
Osaka University Clinical Research Group for Gastroenterological Study
Publikationsdatum
01.04.2012
Verlag
Springer Japan
Erschienen in
Gastric Cancer / Ausgabe 2/2012
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-011-0098-1

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