Abstract
Purpose
Patients diagnosed with early gastric cancer located in the middle third of the stomach have two major surgical options, namely a conventional distal gastrectomy with Billroth I anastomosis (DG) or a pylorus-preserving gastrectomy (PPG). Pyloruspreserving gastrectomy is thought to have greater functional benefits than DG, but the evaluation of its prognosis and outcome has so far been insufficient.
Methods
Between 1997 and 2007, 133 patients were diagnosed with early gastric cancer located in the middle third of the stomach. Distal gastrectomy was performed in 87 and PPG was performed in 46 of these patients. The clinicopathological characteristics were compared between the groups.
Results
There were fewer dissected lymph nodes in PPG (mean: 21.9) than in DG (mean: 30.4, P = 0.001). Complications were detected in 16.1% of DG patients and in 6.5% of PPG patients. The occurrence of stasis after PPG (6.5%) was similar to that observed after DG (6.9%). One patient in the DG group died from cancer recurrence, but cancer recurrence was not detected in the PPG group. Although the difference was not significant, the overall 5-year survival rate in the 46 PPG patients (95%) was better than that in the 87 DG patients (86%, P = 0.087).
Conclusions
Pylorus-preserving gastrectomy patients had fewer postoperative complications than DG patients. The long-term follow-up of these patients will clarify the nutritional and prognostic benefits of PPG.
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References
Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery 1967;61:838–845.
Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 2008;95:1131–1135.
Kodama M, Koyama K. Indications for pylorus preserving gastrectomy for early gastric cancer located in the middle third of the stomach. World J Surg 1991;15:628–634.
Isozaki H, Okajima K, Momura E, Ichinona T, Fujii K, Izumi N, et al. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 1996;83:266–269.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1998;1:10–24.
Zhang D, Shimoyama S, Kaminishi M. Feasibility of pyloruspreserving gastrectomy with a wider scope of lymphadenectomy. Arch Surg 1998;133:993–997.
Nakane Y, Akehira K, Inoue K, Iiyama H, Sato M, Masuya Y, et al. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Hepatogastroenterology 2000;47:590–595.
Shibata C, Shiiba KI, Funayama Y, Ishii S, Fukushima K, Mizoi T, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg 2004;28:857–861.
Tomita R, Takizawa H, Tanjoh K. Physiologic effects of cisapride on gastric emptying after pylorus-preserving gastrectomy for early gastric cancer. World J Surg 1998;22:35–41.
Michiura T, Nakane Y, Kanbara T, Nakai K, Inoue K, Yamamichi K, et al. Assessment of the preserved function of the remnant stomach in pylorus-preserving gastrectomy by gastric emptying scintigraphy. World J Surg 2006;30:1277–1283.
Park DJ, Lee H-J, Jung HC, Kim WH, Lee KU, Yang H-K. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 2008;32:1029–1036.
Yamaguchi T, Ichikawa D, Kurioka H, Ikoma H, Koike H, Otsuji E, et al. Postoperative clinical evaluation following pyloruspreserving gastrectomy. Hepatogastroenterology 2004;51:883–886.
Imada T, Rino Y, Takahashi M, Hatori S, Tanaka J, Shiozawa M, et al. Gastric emptying after pylorus-preserving gastrectomy in comparison with conventional subtotal gastrectomy for early gastric carcinoma. Surg Today 1998;28:135–138.
Imada T, Rino Y, Takahashi M, Suzuki M, Tanaka J, Shiozawa M, et al. Postoperative functional evaluation of pyloruspreserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery 1998;123:165–170.
Hotta T, Taniguchi K, Kobayashi Y, Johata K, Sahara M, Naka T, et al. Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer. Surg Today 2001;31:774–779.
Nakabayashi T, Mochiki E, Garcia M, Haga N, Suzuki T, Asao T, et al. Pyloric motility after pylorus-preserving gastrectomy with or without the pyloric branch of the vagus nerve. World J Surg 2002;26:577–583.
Phillips RJ, Baronowsky EA, Powley TL. Afferent innervation of gastrointestinal tract smooth muscle by the hepatic branch of the vagus. J Comp Neurol 1997;384:248–270.
Nomura E, Isozaki H, Fujii K, Toyoda M, Niki M, Sako S, et al. Postoperative evaluation of function-preserving gastrectomy for early gastric cancer. Hepatogastroenterology 2003;50:2246–2250.
Tomita R, Tanjoh K, Fujisaki S. Novel operative technique for vagal nerve- and pyloric sphincter-preserving distal gastrectomy reconstructed by interposition of a 5 cm jejunal J pouch with a 3 cm jejunal conduit for early gastric cancer and postoperative quality of life 5 years after operation. World J Surg 2004;28:766–774.
Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y, et al. Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer 1992;70:1030–1037.
Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol 2006;13:363–369.
Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg 2007;24:96–100.
Shim JH, Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population. Surg Today 2009;39:481–486.
Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M. Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 2006;203:162–169.
Nunobu S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, et al. Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg 2007;31:2335–2340.
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Ikeguchi, M., Hatada, T., Yamamoto, M. et al. Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach. Surg Today 40, 228–233 (2010). https://doi.org/10.1007/s00595-009-4043-4
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DOI: https://doi.org/10.1007/s00595-009-4043-4