Reconstruction method as an independent risk factor for postoperative bone mineral density loss in gastric cancer

Taisuke Imamura, Shuhei Komatsu, Daisuke Ichikawa, Toshiyuki Kosuga, Takeshi Kubota,
Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji
DOI: 10.1111/jgh.13910
Abstract
Background and Aim
No study has compared the incidence of postoperative bone metabolic disorders between Billroth-I (B-I) and Roux-en-Y (R-Y) reconstructions after distal gastrectomy (DG) for gastric cancer (GC). In this study, we wished to examine the impact of reconstruction method on postoperative bone mineral density (BMD) loss.
Method
We investigated a total of 148 consecutive patients who underwent DG with B-I or R-Y reconstruction for stage I GC between 2008 and 2012. We retrospectively assessed the BMD data using computed tomography (CT) attenuation values of the first lumbar vertebra after surgery.
Results
In multivariate analysis for the whole study series, R-Y reconstruction was identified as an independent risk factor for BMD loss after distal gastrectomy (P < 0.0001; OR = 5.60; 95% CI = 2.38–13.98). Propensity score match analysis was used to overcome bias due to the different covariates for the two groups, even though the 37 patients in the B-I group and the 37 patients in the R-Y group had no significant difference among characteristics, B-I reconstruction was validated to have superiority over R-Y reconstruction for preventing BMD loss in the first 3 years after DG. The cumulative hazard ratio of osteoporosis after gastrectomy was significantly higher in the R-Y group than in the B-I group (P = 0.0427). Conclusions B-I reconstruction might be a preferable method for preventing BMD loss after gastrectomy in GC patients.

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