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World Journal of Surgery

, Volume 36, Issue 4, pp 858–863 | Cite as

Current Status of Pylorus-Preserving Gastrectomy for the Treatment of Gastric Cancer: A Questionnaire Survey and Review of Literatures

  • Chikashi ShibataEmail author
  • Fumito Saijo
  • Masayuki Kakyo
  • Makoto Kinouchi
  • Naoki Tanaka
  • Iwao Sasaki
  • Takashi Aikou
  • The Society for the Study of Postoperative Morbidity After Gastrectomy
Article

Abstract

Purpose

This study was designed to investigate the current status of pylorus-preserving gastrectomy (PPG) for the treatment of gastric cancer by sending a questionnaire to institutions in Japan.

Methods

The questionnaire was prepared and sent to 930 institutions approved by the Japanese Society of Gastroenterological Surgery. Questions were the indications for PPG, preservation of the vagus nerves and the infra-pyloric artery, whether suprapyloric lymph nodes are dissected, distance between the pylorus and the gastrogastrostomy, and the advantages and disadvantages of PPG.

Results

Responses were obtained from 345 institutions (37.1%). In 148 institutions, PPG was included in the choices of operations for gastric cancer and indicated for patients with tumors no deeper than the submucosal layer for differentiated-type carcinoma, or for tumors limited to the mucosa even in poorly differentiated types in 105 institutions. The vagus was preserved in 73.5%, the infrapyloric artery was preserved in 49.4%, and the dissection of suprapyloric lymph nodes were partly performed in 56.2%. The distance between gastrogastrostomy and the pyloric ring was 3–3.9 cm in 43.4% and 2–2.9 cm in 39%. Layer-to-layer anastomosis was the most representative technique for gastrogastrostomy. The advantages of PPG with decreased incidence of dumping syndrome and remnant gastritis were quoted in 130 and 82 institutions, respectively. Delayed gastric emptying was considered as the most frequent disadvantage of PPG, as quoted by 111 institutions.

Conclusions

These results indicate that standard technique in PPG includes the preservation of the vagus and infrapyloric artery, in part dissection of suprapyloric lymph nodes, and layer-to-layer anastomosis for reconstruction. The optimal length of the antral cuff is still controversial.

Keywords

Gastric Cancer Early Gastric Cancer Distal Gastrectomy Vagal Nerve Remnant Gastric Cancer 
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.

Notes

Acknowledgment

The authors thank Dr. Michael G. Sarr, Department of Surgery, Mayo Clinic, Rochester, MN, USA, for reviewing this manuscript.

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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Chikashi Shibata
    • 1
    Email author
  • Fumito Saijo
    • 1
  • Masayuki Kakyo
    • 1
  • Makoto Kinouchi
    • 1
  • Naoki Tanaka
    • 1
  • Iwao Sasaki
    • 1
  • Takashi Aikou
    • 2
  • The Society for the Study of Postoperative Morbidity After Gastrectomy
  1. 1.Division of Biological Regulation and Oncology, Department of SurgeryTohoku University Postgraduate School of MedicineSendaiJapan
  2. 2.Department of SurgeryKagoshima UniversityKagoshimaJapan

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