Comparative analysis of surgical treatment results in case of distal resection in patients with gastric cancer with reconstruction according to Billroth-I and on the Roux-en-Y loop of the small intestine

Background. Gastric cancer is a leading cause of cancer-related mortality worldwide. Laparoscopic distal gastrectomy is the standard surgical treatment for early and locally advanced gastric cancer; however, the optimal reconstruction method — Billroth-1 gastroduodenostomy or Roux-en-Y gastrojejunostomy — remains under investigation. Objective. To evaluate the safety of laparoscopic distal gastrectomy with Billroth-1 gastroduodenostomy compared to Roux-en-Y gastrojejunostomy in patients with stage I and II gastric cancer during the early postoperative period. Material and methods. This prospective non-randomized study included patients with stage I and II gastric adenocarcinoma (TNM 8th edition) undergoing radical surgery at the Moscow Multidisciplinary Clinical Center «Kommunarka» from September 2022 to December 2023. Inclusion criteria: age ≥18 years, ECOG performance status 0—2, ASA physical status I—III. Exclusion criteria: severe intra-abdominal adhesions, destructive pancreatitis, severe comorbidities, psychiatric disorders, open or palliative surgeries. Results. Of 122 patients, 34 underwent Billroth-1 gastroduodenostomy and 88 underwent Roux-en-Y gastrojejunostomy. Billroth-1 procedures were associated with shorter operative time (226 vs. 279 minutes, p<0.001), reduced intraoperative blood loss (33 vs. 76 ml, p<0.001), and shorter postoperative hospital stay (7 vs. 9 days, p<0.001). The rates of postoperative complications and mortality did not differ significantly between the groups (p>0.05). Conclusion. Laparoscopic distal gastrectomy with Billroth-1 gastroduodenostomy is a safe and effective surgical approach for patients with stage I and II gastric cancer, reducing operative time, intraoperative blood loss, and length of postoperative hospital stay without increasing the complication rate.