Abstract
BACKGROUND: The choice between Billroth II and Roux-en-Y reconstruction after radical gastrectomy for gastric cancer (GC) affects the occurrence of reflux and the quality of life (QoL) in patients. AIM: To investigate the QoL and reflux oesophagitis incidence in patients who underwent Billroth II or Roux-en-Y gastrointestinal reconstruction after radical gastrectomy for GC. METHODS: One hundred patients with GC who underwent radical resection at our hospital between January 2023 and December 2024 were enrolled. The patients were divided into two groups based on the postoperative gastrointestinal reconstruction technique: The Billroth II group and the Roux-en-Y group, comprising 50 patients each. The incidence of gastroesophageal reflux within two weeks postoperatively was compared between the groups, including 24-hour reflux episodes, frequency of reflux episodes lasting > 5 minutes, and maximum reflux duration. The reflux symptom scores were measured. Nutritional indicators, including serum albumin (ALB), prealbumin (PA), and haemoglobin (Hb), were assessed 4 and 8 weeks postoperatively. The QoL was evaluated using the QLQ-C30 questionnaire. The incidence of reflux oesophagitis was monitored at 3 months of follow-up. RESULTS: No significant differences were observed between the groups in terms of baseline clinical characteristics (P > 0.05). At 2 weeks postoperatively, the Roux-en-Y group exhibited significantly lower 24-hour reflux episodes, episodes lasting > 5 minutes, and maximum reflux duration than the Billroth II group (P < 0.05). The Roux-en-Y group exhibited significantly lower reflux symptom scores, including epigastric burning, acid regurgitation, upper abdominal distension, and upper abdominal pain, than the Billroth II group (P < 0.05). No significant differences were observed in the peripheral blood ALB, PA, or Hb levels at 4 and 8 weeks postoperatively between the two groups (P > 0.05). The QLQ-C30 scores at 4 and 8 weeks postoperatively were significantly higher in the Roux-en-Y group than in the Billroth II group (P < 0.05). At the 3-month postoperative follow-up, the incidence of reflux oesophagitis was 4.0% in the Roux-en-Y group, significantly lower than the 16.0% observed in the Billroth II group (P < 0.05). CONCLUSION: Among patients with GC undergoing gastrointestinal reconstruction, Roux-en-Y procedures resulted in fewer cases of gastroesophageal reflux and milder symptoms than Billroth II procedures. Nutritional status was comparable postoperatively between the two reconstruction techniques. However, the former significantly affects the patients' QoL less favourably and exhibits a lower incidence of reflux oesophagitis, demonstrating considerable clinical significance.