Randomized clinical trial of Roux-en-Y versus rho-Roux-en-Y reconstruction after distal gastrectomy for gastric cancer -: An interim report

Roux-Y (RY) reconstruction of gastrojejunal continuity is an established means of draining the gastric remnant after distal gastrectomy. The main advantage of the RY operation is that it prevents bile and pancreatic juice from reaching the gastric mucosa, but the gastrojejunostomy may cause the delayed gastric emptying (DGE), including RY syndrome. This syndrome was diagnosed based on clinical criteria, which included epigastric fullness, postprandial pain, nausea, and vomiting of food. The prevalence of the syndrome has ranged from 10% to 20%, but the factors leading to its development are not well known. Recently, RY reconstructions have been frequently used after gastrectomy for gastric cancer, and thus the occurrence of DGE has been sometimes observed. Once it occurs, patient's QOL is reduced and the hospital stay is prolonged. Our data has indicated that the DGE after RY operation was more frequent than that after Billroth-I (BI). Furthermore, rho-Roux-Y reconstruction (rRY), RY reconstruction with rho-shaped anastomosis, is also an established operation, and has been reported to be effective to prevent RY syndrome. Therefore, we conducted this phase M trial about RY vs rRY reconstruction after gastric cancer resection. Primary endpoint was to determine the frequency of DGE, and secondary points were the length of post-operative stay, post-operative complications, and some nutritional status after operation. We have enrolled 15 patients to this study at the present time, and will report this study protocol in progress.