Evaluation of the efficacy and safety of the augmented rectangle technique for Billroth-I reconstruction in laparoscopic distal gastrectomy for gastric cancer: comparison with Roux-en-Y reconstruction.

[BACKGROUND] Laparoscopic distal gastrectomy confers a large rectangular anastomotic stoma, which can be repaired with an augmented rectangle technique anastomosis in an intracorporeal Billroth-I reconstruction. We aimed to evaluate the safety and feasibility of the augmented rectangle technique (ART) for anastomosis.

[METHODS] We retrospectively compared the surgical outcomes and postoperative nutritional statuses of patients who received Billroth-I (n = 285; ART group) or Roux-en-Y (n = 72; R-Y group) reconstruction between January 2013 and December 2023 following laparoscopic distal gastrectomy for gastric cancer at our hospital. Furthermore, postoperative changes in nutritional status of patients who did or did not receive postoperative chemotherapy were compared for at least 1 year in both ART and R-Y groups (n = 198 and n = 42, respectively).

[RESULTS] Among the 357 participants, patients in the ART (196 men and 89 women) and R-Y (54 men and 18 women) groups had a median age of 71 and 74 years, respectively. The ART group, compared to the R-Y group, had significantly shorter operative time (260 min vs. 326 min), less blood loss (32 mL vs. 98 mL), and shorter postoperative hospital stay (9 days vs. 10 days) (all p < 0.001). There was no significant intergroup difference in anastomosis-related complications or anastomotic leakage [ART group vs. R-Y group: 3 (1.1%) vs. 1 (1.4%); p = 0.814 for both]. No patient had anastomotic stenosis or hemorrhage. At 3, 6, and 12 months, there was no significant intergroup difference in the hemoglobin and serum albumin levels or the postoperative weight change (ART group vs R-Y group: - 6.7% vs. - 7.9%, p = 0.262; - 7.1% vs. - 8.3%, p = 0.726; and - 7.0% vs. - 7.9%, p = 0.905, respectively), despite a favorable tendency in the ART group.

[CONCLUSIONS] The augmented rectangle technique of anastomosis is a safe, effective technique for total intracorporeal Billroth-I reconstruction and confers favorable postoperative outcomes and satisfactory oral intake.