Roux‐en‐Y versus Billroth‐I reconstruction after distal gastrectomy for gastric cancer

Background Gastric cancer is the fifth most common cancer diagnosed worldwide. Due to improved early detection rates of gastric cancer and technological advances in treatments, a significant improvement in survival rates has been achieved in people with cancer undergoing gastrectomy. Subsequently, there has been increasing emphasis on postgastrectomy syndrome (e.g. fullness, delayed emptying, and cold sweat, amongst others) and quality of life postsurgery. However, it is uncertain which types of reconstruction result in better outcomes postsurgery. Objectives To assess the evidence on health‐related quality of life and safety outcomes of Roux‐en‐Y and Billroth‐I reconstructions after distal gastrectomy for people with gastric cancer. Search methods We searched the Cochrane Library and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase on 4 May 2021. We checked the reference lists of the included studies and contacted manufacturers and professionals in the field. There were no language restrictions. Selection criteria Randomised controlled trials (RCTs) allocating participants to Roux‐en‐Y reconstruction or Billroth‐I reconstruction after distal gastrectomy for gastric cancer. Data collection and analysis Two review authors independently screened studies identified by the search for eligibility and extracted data. The primary outcomes were health‐related quality of life after surgery and incidence of anastomotic leakage. The secondary outcomes included body weight loss, incidence of bile reflux, length of hospital stay, and overall morbidity. We used a random‐effects model to conduct meta‐analyses. We assessed risk of bias of the included studies in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and the certainty of the evidence using the GRADE approach. Main results We included eight RCTs (942 participants) in the review. One study included both cancer patients and benign disease patients such as stomach ulcers. Two studies compared Roux‐en‐Y, Billroth‐I, and Billroth‐II reconstructions, whilst the other studies compared Roux‐en‐Y and Billroth‐I directly. For the primary outcomes, the evidence suggests that there may be little to no difference in health‐related quality of life between Roux‐en‐Y and Billroth‐I reconstruction (standardised mean difference 0.04, 95% confidence interval (CI) −0.11 to 0.18; I² = 0%; 6 studies; 695 participants; low‐certainty evidence due to study limitations and im