Background The reconstruction method with better short-term outcomes after distal gastrectomy in gastric cancer patients with type 2 diabetes mellitus remains unclear.
Objective To compare the short-term outcomes between Billroth Ⅰ(B-Ⅰ) and Roux-en-Y(R-Y) reconstruction after distal gastrectomy in gastric cancer patients with type 2 diabetes mellitus.
Methods Clinical data about 259 gastric cancer patients with type 2 diabetes mellitus who underwent distal gastrectomy in our hospital from January 2010 to December 2020 were retrospectively analyzed. The patients were divided into B-Ⅰ group (n=109) and R-Y group (n=150). Propensity score matching (PSM) method was used to balance the variables between the two groups. The operation time, postoperative hospital stay and the incidence of early postoperative complications of the two groups were compared.
Results After PSM, a total of 170 cases were included in the subsequent analysis (85 cases in each group). There was no significant difference in preoperative clinical and pathological data between the two groups after matching (all P>0.05). The operation time (MdIQR, 210 184, 242.5 min vs 190 164, 235 min, P=0.028), postoperative hospital stay (MdIQR, 10 8,12.5 d vs 9 7, 11.5 d, P=0.023) of the R-Y group was longer than that of the B-Ⅰ group. The incidence of grade ≥Ⅱ early postoperative complication (41.2% 35/85 vs 20.0% 17/85, P=0.003), postoperative gastroparesis (15.3% 13/85 vs 4.7% 4/85, P=0.021) of the R-Y group was higher than that of the B-Ⅰ group. There was no significant difference in fasting plasma glucose on the first, third, fifth and seventh day after operation between the two groups (all P>0.05).
Conclusion Compared with the R-Y reconstruction, B-Ⅰ reconstruction can shorten the operating time and accelerate postoperative recovery after distal gastrectomy in gastric cancer patients with type 2 diabetes mellitus, with the advantages of reducing the incidence of grade ≥Ⅱ early postoperative complications and postoperative gastroparesis.
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