Comparison of Clinical Outcomes Between Billroth-I and Roux-en-Y Reconstruction Following Minimally Invasive Distal Gastrectomy for Gastric Cancer: A Multicenter Retrospective Propensity Score-Matched Analysis.

Purpose: Gastric cancer (GC) is the third leading cause of cancer deaths, with surgery as the primary treatment; however, the outcomes of different types of surgeries still need to be understood further. This study evaluated the surgical outcomes and prognosis after minimally invasive distal gastrectomy (MIDG) for GC in a multicenter retrospective cohort using propensity score matching.

Methods: This study retrospectively enrolled 688 patients who underwent curative MIDG for GC at five institutions between January 2018 and December 2024. Patients were categorized into Billroth-I reconstruction (B-I) and Roux-en-Y (R-Y) reconstruction groups. Propensity score matching was performed using the following covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, Japanese Classification of Gastric Carcinoma stage, neoadjuvant chemotherapy, and adjuvant chemotherapy. Surgical outcomes and prognoses were compared.

Results: Three hundred propensity score-matched pairs were identified. The R-Y group had longer median operation time [309 (131 to 531) min vs. 265 (126 to 532) min; P<0.001], longer postoperative hospital stay [10 (5 to 110) d vs. 10 (5 to 43) d; P=0.042], and greater median blood loss (P=0.047) than the B-I group. Complications of Clavien-Dindo (CD) grade II (P<0.001) and grade III (P=0.027) were more frequent in the R-Y group than in the B-I group. Five-year overall survival (OS) was significantly higher in the B-I group than in the R-Y group (91.1% vs. 83.4%; P=0.019), whereas 5-year relapse-free survival (RFS) showed no significant difference between these 2 groups (P=0.056). Independent prognostic factors included reconstruction method, postoperative complications (≥CD III), and lymph node metastasis (pN) for OS and age (≥80), pT, and pN for RFS.

Conclusions: Patients who underwent R-Y reconstruction had more frequent postoperative complications than those who underwent B-I reconstruction after MIDG. Although not significantly associated with RFS, these complications may affect OS. The findings of this study could help develop strategies for improving GC treatment.