Background: Controversy persists regarding digestive reconnection following subtotal gastrectomy for carcinoma. A randomized prospective trial comparing Billroth I and Billroth II procedures for mortality, digestive comfort, survival, and patterns of recurrence was conducted.
Study design: Thirty patients underwent Billroth I and 32 patients underwent Billroth II procedures. Stages I, II, III, and IV of the tumor-node-metastasis (TNM) staging system accounted for 27, 16, 47, and 10 percent of tumors, respectively. Billroth I and II groups were well-matched for clinicopathologic variables.
Results: Duration of surgery, volume of blood transfused, and abdominal drainage were similar in the two groups. The duration and volume of gastric drainage were greater in patients following Billroth I procedures. Four fistulas were noted in the Billroth I group and one fistula developed in a patient following Billroth II gastrectomy. Billroth I gastrectomy and low preoperative serum albumin were independent risk factors for fistula development. Fistula development accounted for an increase in the duration of hospital stay following Billroth I procedures. Hospital mortality was similar in the two groups. Five-year actuarial survival rate was 42 and 40 percent for patients undergoing Billroth I and Billroth II procedures, respectively. Long-term survival was similar for patients having each procedure, and this was verified for all TNM stages. There were seven recurrences at the hepatic pedicle in the Billroth I group and one recurrence of this type in the Billroth II group, requiring four reinterventions.
Conclusions: Digestive comfort and long-term survival are similar after Billroth I and Billroth II gastrectomy for carcinoma. Billroth I gastrectomy is associated with an increased risk of fistula development and of recurrence of carcinoma at the hepatic pedicle.