To compare the short-term safety and costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and Billroth Ⅱ (B Ⅱ) + Braun reconstruction after radical gastrectomy of distal gastric cancer.

Clinical data from our prospective database of radical gastrectomy were systematically analyzed. The patients who underwent laparoscopic gastrectomy with uncut Roux-en-Y or BⅡ+ Braun reconstruction between March 1st, 2015 and June 30th, 2017 were screened out for further analysis. Both the reconstructions were completed by linear staplers. Uncut Roux-en-Y reconstruction was performed with a 45 mm no-knife linear stapler (ATS45NK) on the afferent loop below the gastrojejunostomy. Continuous variables were compared using independent samples t test or Mann-Whitney U. The frequencies of categorical variables were compared using Chi-squared or Fisher exact test.

Eighty-one patients were in uncut Roux-en-Y group and 58 patients were in BⅡ+Braun group. There were no significant differences between uncut Roux-en-Y group and BⅡ+Braun group in median age (56.0 years vs. 56.5 years, P = 0.757) , gender (male/female, 52/29 vs. 46/12, P = 0.054) , history of abdominal surgery (yes/no, 10/71 vs. 4/54, P = 0.293) , neoadjuvant chemotherapy (yes/no, 21/60 vs. 11/47, P = 0.336) , BMI (thin/normal/overweight/obesity, 2/49/26/3 vs. 3/39/14/2, P = 0.591) , NRS 2002 score (1/2/3/4, 58/15/5/3 vs. 47/5/3/3, P = 0.403) , pathological stage (0/Ⅰ/Ⅱ/Ⅲ, 3/41/20/17 vs. 1/28/13/16, P = 0.755) , median tumor diameter in long axis (2.5 cm vs. 3.0 cm, P = 0.278) , median tumor diameter in short axis (2.0 cm vs. 2.0 cm, P = 0.126) and some other clinical and pathological characteristics. There were no significant differences between uncut Roux-en-Y group and BⅡ+Braun group in morbidity of postoperative complication more severe than grade I [12.3% (10/81) vs. 17.2% (10/58) , P= 0.417], morbidity of anastomotic complication [1.2% (1/81) vs. 0, P = 1.000] or hospitalization costs [ (94 000 ± 14 000) yuan vs. (95 000 ± 16 000) yuan, P = 0.895]. The median first time to liquid diet (57.1 hours vs. 70.8 hours, P = 0.017) and median postoperative hospital stay (9 days vs. 11 days, P = 0.003) of the patients in uncut Roux-en-Y group were shorter than those in BⅡ+Braun group.

Laparoscopic assisted or totally laparoscopic uncut Roux-en-Y reconstruction after radical gastrectomy of distal gastric cancer is safe and feasible with better recovery than BⅡ+Braun reconstruction.

Stomach neoplasms; Anastomosis; Uncut Roux-en-Y; BⅡ+Braun; Totally laparoscopic gastrectomy; Safety; Costs