Original article: Safety, Effectiveness, and Quality of Life Outcomes of Billroth I Reconstruction with Modified Delta Anastomosis in Laparoscopic Gastrectomy for Gastric Cancer: A European Perspective

Boris Pomortsev ^1,2* Sergey Sinyakhin ¹ Kamil Dalgatov ^1,2 Alexander Sazhin ^1,2

• ¹ Other, Moscow, Russia
• ² Pirogov Russian National Research Medical University, Moscow, Moscow Oblast, Russia

Modified Billroth I and Roux-en-Y reconstructions are widely used methods following laparoscopic distal gastrectomy for gastric cancer, each with unique implications for perioperative outcomes and quality of life. This study aims to compare these two techniques in terms of safety, efficacy, and postoperative quality of life in a European cohort.A prospective, single-center cohort study was conducted at the Multidisciplinary Medical Center Kommunarka from September 2022 to September 2023. A total of 122 patients with gastric cancer stages I-III were enrolled, with 34 undergoing modified Billroth I reconstruction and 88 undergoing Roux-en-Y reconstruction. Data on demographics, perioperative outcomes, complications, and quality of life (assessed using EORTC QLQ-C30 and STO-22 scales) were collected and analyzed. Statistical comparisons were made using t-tests, chi-square tests, and Mann-Whitney U tests, with significance set at p < 0.05.Modified Billroth I reconstruction demonstrated shorter operative times (223.1 ± 13.7 vs. 281.6 ± 13.7 minutes, P < 0.0001) and reduced intraoperative blood loss (31.8 ± 6.18 vs. 76.1 ± 9.9 mL, P < 0.0001) compared to Roux-en-Y. Postoperative hospital stay was also significantly shorter in the Billroth I group (7.1 ± 0.68 vs. 9.03 ± 0.8 days, P < 0.0001). Quality of life assessments revealed higher physical functioning (PF) scores and lower fatigue (FA) in the Billroth I group (P = 0.0432 and P = 0.024, respectively), with no significant differences in other functional or symptom domains between groups. No statistically significant differences were observed in complication rates, major complications, or mortality between the groups.Our findings suggest that modified Billroth I reconstruction may offer advantages in perioperative outcomes, including reduced operative time, blood loss, and improved physical functioning, without compromising safety compared to Roux-en-Y. Further multicenter studies with larger sample sizes and extended follow-up are necessary to confirm these benefits and refine surgical decision-making in gastric cancer treatment.