Comparison of Billroth I, Billroth II, and Roux-en-Y reconstructions after distal gastrectomy according to functional recovery: a meta-analysis

Gastric cancer is common, with a high mortality rate. Billroth I (B-I), Billroth II (B-II), and Roux-en-Y (R-Y) are the major reconstruction procedures after distal gastrectomy. In our study, we aimed to evaluate the functional recovery following the B-I, B-II, and R-Y reconstructions through a network meta-analysis.PubMed, Embase, and Cochrane Library databases were searched until April 2018. From the included studies, first oral-intake time, early complications, endoscopic finding, quality of life (QoL), and body weight changes were extracted as the short- and long-term outcomes of reconstructions. The network meta-analysis was performed with R 3.4.2 software as well as "gemtc" and "forestplot" packages.Our work included a total of 26 articles involving 6212 patients with gastric cancer. Network meta-analysis revealed that R-Y reconstruction has a lower risk and degree of residual gastritis and bile reflex than B-I and B-II reconstructions. However, no differences in first oral-intake time, complications, risk of reflux esophagitis, and residual food, QoL, and body weight changes existed among the three reconstructions.R-Y may be the appropriate reconstruction procedure after distal gastrectomy based on postoperative functional recovery. However, more reports with a large sample size are warranted to investigate its long-term outcomes.