World Journal of Surgery

, Volume 27, Issue 6, pp 725–733 | Cite as

Pathophysiological Studies on the Relationship between Postgastrectomy Syndrome and Gastric Emptying Function at 5 Years after Pylorus-preserving Distal Gastrectomy for Early Gastric Cancer

  • Ryouichi Tomita
  • Shigeru Fujisaki
  • Katsuhisa Tanjoh
Original Scientific Reports


Pylorus-preserving distal gastrectomy (PPG) has frequently been performed on patients with early gastric cancer in Japan to prevent the postgastrectomy syndrome seen after conventional distal gastrectomy (CDG). The long-term postoperative quality of life (QOL) and gastric emptying function in patients after PPG has not been assessed in detail. To clarify the usefulness of PPG for treating early gastric cancer we investigated the relation between postgastrectomy syndrome and gastric emptying function 5 years after PPG and then compared the results with those 5 years after CDG. Altogether, 32 patients who underwent curative gastrectomy at our clinic for early gastric cancer (submucosal cancer without lymph node metastasis) were studied. Ten subjects who underwent PPG with D2 lymphadenectomy without preserving the hepatic and pyloric branches of the vagal nerve [group A: eight men, two women; age 33–70 years (mean 60.7 years)] were interviewed and asked about appetite, weight loss, epigastric fullness, reflux esophagitis, and early dumping syndrome. They were compared with patients after CDG [group B: 36–72 years (mean 63.6 years)]. Esophagogastric endoscopy, abdominal ultrasonography, and gastric emptying function were also studied. The gastric emptying time of a semisolid diet was measured with a radioisotope method using 99mTc-labeled rice gruel; the gastric emptying time of a liquid diet was measured with the acetaminophen method using orange juice. The control subjects (group C) consisted of 18 healthy volunteers (10 men, 8 women) without gastrointestinal symptoms aged 38 to 68 years (mean 60.8 years). The following results were obtained: PPG (group A) alleviated postoperative gastrointestinal symptoms such as appetite loss, reflux esophagitis, early dumping syndrome, lost body weight, endoscopic reflux esophagitis, endoscopic gastritis in the remnant stomach, and postogastrectomy cholecystolithiasis better than did CDG (group B). The only weak point with the PPG procedure was that it produced a feeling of epigastric fullness. The pattern of the gastric emptying curve for the semisolid diet was almost the same among groups A, B, and C, although delayed gastric emptying was clearly more frequent in group A than in group B or C (p < 0.05). Gastric emptying with the liquid diet in group B was significantly faster than that in groups A and C (p < 0.01). Gastric emptying in groups A and C was similar. These results showed that PPG improved the postoperative QOL, but the delayed emptying of semisolid diet after PPG led to a feeling of epigastric fullness after meals due to retention of contents in the residual stomach. Epigastric fullness after meals continued in many patients after PPG. Thus the only disadvantage of the PPG procedure is the sensation of epigastric fullness and gastric stasis due to delayed gastric emptying of a semisolid diet.


Early Gastric Cancer Reflux Esophagitis Vagal Nerve Remnant Stomach Residual Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Kodama, M, Koyama, K, Chida, T,  et al. 1995Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancerWorld J. Surg.19456461PubMedGoogle Scholar
  2. 2.
    Imada, T, Rino, Y, Takahashi, M,  et al. 1998Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomySurgery123165170CrossRefPubMedGoogle Scholar
  3. 3.
    Isozaki, H, Okajima, K, Nomura, E,  et al. 1996Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancerBr. J. Surg.83266269CrossRefPubMedGoogle Scholar
  4. 4.
    Maki, T, Shiratori, T, Hatafuku, T,  et al. 1967Pylorus-preserving gastrectomy as an improved operation for gastric ulcerSurgery61838842PubMedGoogle Scholar
  5. 5.
    Zhang, D, Shimoyama, S, Kaminishi, M 1998Feasibility of pylorus-preserving gastrectomy with a wider scope of lymphadenectomyArch. Surg.133993997CrossRefPubMedGoogle Scholar
  6. 6.
    Nakane, Y, Akehira, K, Inoue, K,  et al. 2000Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancerHepatogastroenterology.47590595PubMedGoogle Scholar
  7. 7.
    Hotta, T, Taniguchi, K, Kobayashi, Y,  et al. 2001Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancerSurg. Today31774779CrossRefPubMedGoogle Scholar
  8. 8.
    Kodera, Y, Yamamura, Y, Kanemitsu, Y,  et al. 2001Lymph node metastasis in cancer of the middle-third stomach: criteria for treatment with a pylorus-preserving gastrectomySurg. Today31196203CrossRefPubMedGoogle Scholar
  9. 9.
    Tomita, R, Fujisaki, S, Tanjoh, K,  et al. 2001A novel operative technique on proximal gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of the vagal nerve and lower esophageal sphincterHepatogastroenterology.4811861191PubMedGoogle Scholar
  10. 10.
    Tomita, R, Fujisaki, S, Tanjoh, K,  et al. 2001Operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of vagal nerve, lower esophageal sphincter, and pyloric sphincter for early gastric cancerWorld J. Surg.2515241531PubMedGoogle Scholar
  11. 11.
    Christian, PE, Datz, FL, Sorenson, JA 1983Technical factors in gastric emptying studiesJ. Nucl. Med.24264268PubMedGoogle Scholar
  12. 12.
    Mistiaen, W, Hee, R, Blockx, P,  et al. 2001Gastric emptying rate for solid and for liquid test meals in patients with dyspeptic symptoms after partial gastrectomy and after vagotomy followed by partial gastrectomyHepatogastroenterology.48299302PubMedGoogle Scholar
  13. 13.
    Matsuhisa, T, Oshima, H 1993Gastric emptying function determination with acetaminophen method: results in upper gastrointestinal diseasesJ. Smooth Muscle Res.29187189Google Scholar
  14. 14.
    Takamiya, H, Koufuji, K, Shirouzu, K 2002The influence of pylorus-preserving partial gastrectomy on carcinogenesis of residual gastric mucosa in the ratSurg. Today32134141CrossRefPubMedGoogle Scholar
  15. 15.
    Nagaoka, K 1968Electromyographic study on the mechanism of delayed gastric emptying after vagotomy in dogsTohoku J. Exp. Med.95113PubMedGoogle Scholar
  16. 16.
    Shibata, C, Sasaki, I, Naito, H,  et al. 1995Gastrointestinal motor activity after pylorus-preserving gastrectomy with or without vagotomy in dogsJ. Am. Coll. Surg.181545551PubMedGoogle Scholar
  17. 17.
    Mochiki, E, Kuwano, H, Nakabayashi, T 2001Pyloric relaxation regulated via intramural neural pathway of the antrumDig. Dis. Sci.4623072313CrossRefPubMedGoogle Scholar
  18. 18.
    Nakabayashi, T, Mochiki, E, Garcia, M,  et al. 2002Pyloric motility after pylorus-preserving gastrectomy with or without the pyloric branch of the vagus nerveWorld J. Surg.26577583CrossRefPubMedGoogle Scholar
  19. 19.
    Nakane, Y, Michiura, T, Inoue, K,  et al. 2002Length of the antral in pylorus-preserving gastrectomyBr. J. Surg.89220224CrossRefPubMedGoogle Scholar
  20. 20.
    Nabae, T, Takahashi, S, Konomi, H,  et al. 2001Effect of prepyloric gastric transection and anastomosis on sphincter of Oddi cyclic motility in conscious dogsJ. Gastroenterol.36530537CrossRefPubMedGoogle Scholar
  21. 21.
    Tomita, R, Takizawa, H, Tanjoh, K 1998Physiologic effects of cisapride on gastric emptying after pylorus-preserving gastrectomy for early gastric cancerWorld J. Surg.223541CrossRefPubMedGoogle Scholar
  22. 22.
    Takizawa, H, Tomita, R, Shibata, M,  et al. 1997Clinicopathological study on early gastric cancer with lymph node metastasis: indication for limited operationNihon. Univ. Med. Assoc.53303308Google Scholar
  23. 23.
    Tomita R, Fujisaki S, Tanjoh, K (2001) Physiological effects of mosapride in patients after conventional distal gastrectomy for early gastric cancer. Med. Postgrad.: 53-57Google Scholar
  24. 24.
    Forster, J, Sarosiek, I, Delcore, R,  et al. 2001Gastric pacing is a new surgical treatment for gastroparesisAm. J. Surg.182676681CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2003

Authors and Affiliations

  • Ryouichi Tomita
    • 1
    • 2
  • Shigeru Fujisaki
    • 2
  • Katsuhisa Tanjoh
    • 2
  1. 1.Department of SurgeryNippon Dental University School of Dentistry at TokyoTokyo 102-8158Japan
  2. 2.First Department of SurgeryNihon University School of MedicineTokyo 173-0032Japan

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