Propensity-score-matched analysis of a multi-institutional dataset to compare postoperative complications between Billroth I and Roux-en-Y reconstructions after distal gastrectomy
Propensity-score-matched analysis of a multi-institutional dataset to compare postoperative complications between Billroth I and Roux-en-Y reconstructions after distal gastrectomy
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DOI：
10.1007/s10120-020-01048-6
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发表时间：
2020-02-17
期刊：
影响因子：
7.4
通讯作者：
Kodera, Yasuhiro
中科院分区：
文献类型：
--
作者：
Nakanishi, Koki;Kanda, Mitsuro;Kodera, Yasuhiro
很少有对照良好的研究比较Billroth I（B-I）和Roux-en-Y（R-Y）的术后并发症。本研究的目的是比较远端胃切除术后重建方法的总体和严重术后并发症的发生率。方法我们对2010年至2014年接受B-I或R-Y重建的远端胃切除术患者进行了多机构数据集研究。使用倾向评分来严格平衡重要变量，我们比较了两种技术之间的术后并发症。结果经配对后，共纳入1014例患者（每组507例）。R-Y组的术后并发症发生率明显高于B-I组（29%比17%，P < 0.0001）。腹腔脓肿的发生率（4.3% vs 1.8%，P = 0.0177），肠梗阻（2.6% vs 0.6%，P = 0.0203），胃排空延迟（5.3%vs1.0%，P < 0.0001），R-Y组明显高于B-I组;两组的渗漏率无显著性差异（3.4%vs 4.1%，P = 0.5084）。R-Y组≥ III级严重术后并发症的发生率显著高于B-I组（13% vs 7.1%，P = 0.0013）。多变量分析显示，R-Y重建是总体术后并发症（比值比1.58，P = 0.0044）和≥ III级严重术后并发症（比值比1.75，P = 0.0127）的强独立风险因素。森林图显示，在任何亚组中，R-Y重建与总体和≥ III级严重术后并发症的风险均较高相关。结论R-Y重建术与术后并发症的增加有关，术后并发症严重。
Background Few well-controlled studies have compared postoperative complications between Billroth I (B-I) and Roux-en-Y (R-Y). The aim of the present study was to compare the incidence of overall and severe postoperative complications by reconstruction method after distal gastrectomy. Methods We performed a multi-institutional dataset study of patients who underwent distal gastrectomy with B-I or R-Y reconstruction from 2010 to 2014. Using propensity scores to strictly balance the significant variables, we compared postoperative complications between the techniques. Results After matching, we enrolled 1014 patients (n = 507 in each group). The incidence of postoperative complications in the R-Y group was significantly higher vs the B-I group (29% vs 17%, P < 0.0001). The incidence of intra-abdominal abscess (4.3% vs 1.8%, P = 0.0177), bowel obstruction (2.6% vs 0.6%, P = 0.0203), and delayed gastric emptying (5.3% vs 1.0%, P < 0.0001) in the R-Y group was significantly higher vs the B-I group, respectively; we saw no significant difference in leakage (3.4% vs 4.1%, P = 0.5084). The incidence of grade >= III severe postoperative complications in the R-Y group was significantly higher vs the B-I group (13% vs 7.1%, P = 0.0013). Multivariable analysis showed that R-Y reconstruction was a strong independent risk factor for overall postoperative complications (odds ratio 1.58, P = 0.0044) and grade >= III severe postoperative complications (odds ratio 1.75, P = 0.0127). A forest plot revealed that R-Y reconstruction was associated with a greater risk of both overall and grade >= III severe postoperative complications in any subgroups. Conclusions R-Y reconstruction was associated with increasing overall postoperative complications, as well as severe postoperative complications.