<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>Billroth-I (B-I) anastomosis 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.</p>
</sec>
<sec><h3>Patients and methods</h3>
<p>Patients with NEGA without distant metastases operated between May 2004 and December 2020 were included. Surgical and oncologic outcomes of distal subtotal gastrectomy were studied in patients with B-I and Billroth II (B-II) anastomoses. Propensity score matching (PSM) was used to adjust for age, gender, tumor size, location, resection type, pT and pN stages.</p>
</sec>
<sec><h3>Results</h3>
<p>A total number of 332 patients underwent distal subtotal gastrectomy for NEGA followed by B-I and B-II anastomoses in 165 (49.7%) and 167 (50.3%) cases, respectively. B-I was applied in patients with smaller tumor size, less advanced pT stage and tumor location in the gastric antrum. The former was also associated with lower proportion of multiorgan resections and shorter operative time. After PSM, these differences became statistically non-significant, except operative time. Postoperative outcomes were similar before and after PSM. Greater lymph node yield was observed in patients with B-I anastomosis. The incidence of recurrence, specifically local recurrence was lower in patients with B-I anastomosis. However, this association was not statistically significant in the multivariable model. Median overall survival was 38 months, without significant differences between the groups.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>The use of B-I anastomosis after distal subtotal gastrectomy for NEGA is associated with satisfactory surgical and oncologic outcomes. B-I anastomosis should be considered as a valid reconstruction method in these patients.</p>
</sec>
</abstract>

Background
Billroth-I (B-I) anastomosis 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.

Patients and methods
Patients with NEGA without distant metastases operated between May 2004 and December 2020 were included. Surgical and oncologic outcomes of distal subtotal gastrectomy were studied in patients with B-I and Billroth II (B-II) anastomoses. 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 underwent distal subtotal gastrectomy for NEGA followed by B-I and B-II anastomoses in 165 (49.7%) and 167 (50.3%) cases, respectively. B-I was applied in patients with smaller tumor size, less advanced pT stage and tumor location in the gastric antrum. The former was also associated with lower proportion of multiorgan resections and shorter operative time. After PSM, these differences became statistically non-significant, except operative time. Postoperative outcomes were similar before and after PSM. Greater lymph node yield was observed in patients with B-I anastomosis. The incidence of recurrence, specifically local recurrence was lower in patients with B-I anastomosis. However, this association was not statistically significant in the multivariable model. Median overall survival was 38 months, without significant differences between the groups.

Conclusions
The use of B-I anastomosis after distal subtotal gastrectomy for NEGA is associated with satisfactory surgical and oncologic outcomes. B-I anastomosis should be considered as a valid reconstruction method in these patients.

Billroth-I anastomosis in distal subtotal gastrectomy for non-early gastric adenocarcinoma

Department of General & Laparoscopic Surgery

Yerevan State Medical University after M. Heratsi

Department of Research & Development, Division of Emergencies and Critical Care

Department of General and Abdominal Surgery

Oslo Centre for Biostatistics and Epidemiology

Radiology and Oncology

This work is licensed under the Creative Commons Attribution 4.0 International License.

Background
Billroth-I (B-I) anastomosis is known as a simple and physiological reconstruction method after distal subtotal gastrectomy for early gastric...

Billroth-I anastomosis in distal subtotal gastrectomy for non-early gastric adenocarcinoma

Article Category: Research Article

Online veröffentlicht: 04. Sept. 2023

Seitenbereich: 356 - 363

Eingereicht: 20. Apr. 2023

Akzeptiert: 27. Juli 2023

DOI: https://doi.org/10.2478/raon-2023-0041

Schlüsselwörter
gastrectomy, anastomosis, Billroth-I, Billroth-II, adenocarcinoma

© 2023 Sevak S Shahbazyan et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Billroth-I anastomosis in distal subtotal gastrectomy for non-early gastric adenocarcinoma

Article Category: Research Article

Online veröffentlicht: 04. Sept. 2023

Seitenbereich: 356 - 363

Eingereicht: 20. Apr. 2023

Akzeptiert: 27. Juli 2023

DOI: https://doi.org/10.2478/raon-2023-0041

Schlüsselwörtergastrectomy, anastomosis, Billroth-I, Billroth-II, adenocarcinoma

© 2023 Sevak S Shahbazyan et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Schlüsselwörter
gastrectomy, anastomosis, Billroth-I, Billroth-II, adenocarcinoma