J Gastric Cancer.  2019 Mar;19(1):111-120. 10.5230/jgc.2019.19.e10.

Short-Term Outcomes of Intracorporeal Delta-Shaped Gastroduodenostomy Versus Extracorporeal Gastroduodenostomy after Laparoscopic Distal Gastrectomy for Gastric Cancer

• Kim YN
• An JY
• Choi YY
• Choi MG
• Lee JH
• Sohn TS
• Bae JM
• Kim S

• KMID: 2458823
• DOI: http://doi.org/10.5230/jgc.2019.19.e10

Abstract

BACKGROUND
Billroth I anastomosis is one of the most common reconstruction methods after distal gastrectomy for gastric cancer. Intracorporeal Billroth I (ICBI) anastomosis and extracorporeal Billroth I (ECBI) anastomosis are widely used in laparoscopic surgery. Here we compared ICBI and ECBI outcomes at a major gastric cancer center.
METHODS
We retrospectively analyzed data from 2,284 gastric cancer patients who underwent laparoscopic distal gastrectomy between 2009 and 2017. We divided the subjects into ECBI (n=1,681) and ICBI (n=603) groups, compared the patients' clinical characteristics and surgical and short-term outcomes, and performed risk factor analyses of postoperative complication development.
RESULTS
The ICBI group experienced shorter operation times, less blood loss, and shorter hospital stays than the ECBI group. There were no clinically significant intergroup differences in diet initiation. Changes in white blood cell counts and C-reactive protein levels were similar between groups. Grade II-IV surgical complication rates were 2.7% and 4.0% in the ECBI and ICBI groups, respectively, with no significant intergroup differences. Male sex and a body mass index (BMI) ≥30 were independent risk factors for surgical complication development. In the ECBI group, patients with a BMI ≥30 experienced a significantly higher surgical complication rate than those with a lower BMI, while no such difference was observed in the ICBI group.
CONCLUSION
The surgical safety of ICBI was similar to that of ECBI. Although the chosen anastomotic technique was not a risk factor for surgical complications, ECBI was more vulnerable to surgical complications than ICBI in patients with a high BMI (≥30).

Keyword

Intracorporeal gastroduodenostomy; Extracorporeal gastroduodenostomy; Laparoscopic distal gastrectomy; Gastric cancer; Body mass index; Surgical injuries

MeSH Terms

Body Mass Index
C-Reactive Protein
Diet
Gastrectomy*
Gastroenterostomy
Humans
Intraoperative Complications
Laparoscopy
Length of Stay
Leukocyte Count
Male
Postoperative Complications
Retrospective Studies
Risk Factors
Stomach Neoplasms*
C-Reactive Protein

Figure

• 

  Fig. 1 Postoperative inflammatory response in the ECBI and ICBI groups. (A) WBC counts of each reconstruction method after laparoscopic gastrectomy. (B) CRP levels by reconstruction method after laparoscopic gastrectomy. ECBI, = extracorporeal Billroth I; ICBI, = intracorporeal Billroth I; WBC = white blood cell; CRP = C-reactive protein.

• 

  Fig. 2 Complication rate according to BMI changes in the ECBI and ICBI groups. BMI = body mass index; ECBI = extracorporeal Billroth I; ICBI = intracorporeal Billroth I.

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