Comparing Quality of Life for Billroth II With Braun Versus Uncut Roux-en-Y Reconstruction After Total Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Clinical Trial.

IntroductionThe decline in mortality and increase in cure rates following distal gastrectomy have led to a growing focus on patient quality of life (QoL). This study aims to compare QoL outcomes between uncut Roux-en-Y (URY) and Billroth-II with Braun anastomosis (BIIB) reconstructions after totally laparoscopic distal gastrectomy (TLDG), and to identify the preferred surgical approach.Materials and MethodsFrom May 2017 to May 2019, a prospective randomized controlled trial (RCT) enrolled 101 gastric cancer patients undergoing TLDG, who were randomly allocated to either URY or BIIB reconstruction. The primary endpoint evaluated the superiority of URY in postoperative QoL at 24 months, as quantified by composite scores from the validated QLQ-C30 version 3.0 and QLQ-STO22 instruments.ResultsAfter TLDG, compared with BIIB, the URY group had lower EORTC QLQ-C 30 3.0 nausea and vomiting scores at 12 (3.6 (3.3) vs 8.3 (5.3)) and 24 (2.7 (3.4) vs 7.5 (4.2), P < 0.001) months; and fewer reflux symptoms in QLQ-STO 22 at 12 (6.7 (8.9) vs 13.7 (16.1)), and 24 months (4.7 (5.9) vs 12.5 (10.7), P < 0.05). Meanwhile, patients who underwent URY also had better Gastrointestinal Symptom Rating Scale scores (P < 0.01), and shorter frequency and duration of bile reflux at 3, 12, and 24 months (P < 0.01); shorter Bilitec monitoring for bilirubin aspiration at 3 (P = 0.0032), 12 (P = 0.0004), and 24 months (P = 0.042); and lower rates of bile reflux gastritis at 3, 12, and 24 months (P < 0.001). The mean pH of morning gastric fluid was obviously lower in the URY group at 1∼7 days postoperatively (P < 0.001).ConclusionURY reconstruction after TLDG effectively reduced short-term bile reflux and improved patients' QoL compared to BIIB reconstruction.