Which is better long-term survival of gastric cancer patients with Billroth I or Billroth II reconstruction after distal gastrectomy? -Impact on 20-year survival rate-

摘要

Background : The question in the title remains unanswered and also is both old and new among gastric surgeons. Although there have been many reports about the early-stage quality of life and postoperative morbidity, they have failed to conclude about the advantages of these two reconstructions after distal gastrectomy. In this study, we summarized more than 30 years of experience and evaluated whether the Billroth I or Billroth II reconstruction procedure is better for patient survival after distal gastrectomy.Methods : From January 1977 to August 2005, a total of 1410 gastric cancer patients underwent distal gastrectomy with Billroth I (n=1184) or Billroth II (n=226) reconstruction in the Department of Gastroenterological Surgery, Tokai University. The 10- and 20-year follow-up cases numbered 980 (82.8%) and 692 (58.4%) for Billroth I, and 213 (94.2%) and 195 (86.3%) for Billroth II as of September 2009, respectively. Among them, 1015 patients (72.0%) received curative resection and were followed to evaluate the types of recurrence.Results : In the patients with Billroth I and Billroth II, the 5-, 10-, 15-, and 20-year survival rates were 77.4%, 66.6%, 56.0%, and 45.7%, and 39.7%, 32.8%, 25.9%, and 19.6%, respectively (P <0.0001; relative risk, 2.683; 95% confidence interval, 2.261?3.183). The patients in stages 1A and 4 showed significantly better survival with Billroth I than with Billroth II. The patients with Billroth II (10/86, 11.6%) showed significantly higher hematogenous recurrence than those with Billroth I (41/929, 4.4%).Conclusions : If gastric cancer patients must receive distal gastrectomy, we recommend they receive Billroth I reconstruction.