Surgical Endoscopy

, Volume 25, Issue 4, pp 1182–1186 | Cite as

Long-term outcome and survival with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer

  • Xiaohua Jiang
  • Naoki Hiki
  • Souya Nunobe
  • Tetsu Fukunaga
  • Koshi Kumagai
  • Kyoko Nohara
  • Hiroshi Katayama
  • Shigekazu Ohyama
  • Takeshi Sano
  • Toshiharu Yamaguchi



Laparoscopically assisted pylorus-preserving gastrectomy (LAPPG) is introduced as a function-preserving operation with minimal invasion for early gastric cancer (EGC). This study aimed to investigate the long-term outcome and survival with LAPPG.


From January 2005 to July 2008, 188 patients with EGC underwent LAPPG. The surgical and long-term outcomes and survival were assessed retrospectively.


The accuracy of the preoperative EGC diagnosis was 92.6%. The median follow-up period was 38 months (range, 2–63 months). Two patients experienced gallstones, and three patients experienced a second primary EGC. One patient with T3N0 gastric cancer died of peritoneal metastasis, and four patients died of other causes. The overall 3-year survival rate was 97.8%, and the disease-specific 3-year survival rate was 99.3%.


The LAPPG procedure is safe in terms of satisfactory long-term outcome and survival for patients with EGC in the middle third of the stomach.


Early gastric cancer Laparoscopy-assisted pylorus-preserving gastrectomy Long-term outcome 


  1. 1.
    Maehara Y, Kakeji Y, Oda S, Takahashi I, Akazawa K, Sugimachi K (2000) Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer. Br J Cancer 83:986–991PubMedCrossRefGoogle Scholar
  2. 2.
    Adachi Y, Mori M, Maehara Y, Kitano S, Sugimachi K (1997) Prognostic factors of node-negative gastric carcinoma: univariate and multivariate analyses. J Am Coll Surg 184:373–377PubMedGoogle Scholar
  3. 3.
    Sano T, Hollowood A (2006) Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg 95:249–255PubMedGoogle Scholar
  4. 4.
    Shibata C, Shiiba KI, Funayama Y, Ishii S, Fukushima K, Mizoi T, Koyama K, Miura K, Matsuno S, Naito H, Kato E, Honda T, Momono S, Ouchi A, Ashino Y, Takahashi Y, Fujiya T, Iwatsuki A, Sasaki I (2004) Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg 28:857–861PubMedCrossRefGoogle Scholar
  5. 5.
    Park do J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK (2008) Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 32:1029–1036PubMedCrossRefGoogle Scholar
  6. 6.
    Imada T, Rino Y, Takahashi M, Suzuki M, Tanaka J, Shiozawa M, Kabara K, Hatori S, Ito H, Yamamoto Y, Amano T (1998) Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery 123:165–170PubMedCrossRefGoogle Scholar
  7. 7.
    Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2007) Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer 10:167–172PubMedCrossRefGoogle Scholar
  8. 8.
    Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, Oba H, Aoki T, Minami M, Hirakawa K (2010) A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. J Gastrointest Surg 14:958–964PubMedCrossRefGoogle Scholar
  9. 9.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72PubMedCrossRefGoogle Scholar
  10. 10.
    Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247:962–967PubMedCrossRefGoogle Scholar
  11. 11.
    Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M (2006) Laparoscopy-assisted pylorus-preserving gastrectomy with quality-controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 203:162–169PubMedCrossRefGoogle Scholar
  12. 12.
    Hiki N, Kaminishi M (2005) Pylorus-preserving gastrectomy in gastric cancer surgery: open and laparoscopic approaches. Langenbecks Arch Surg 390:442–447PubMedCrossRefGoogle Scholar
  13. 13.
    Nunobe S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, Yamaguchi T (2007) Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg 31:2335–2340PubMedCrossRefGoogle Scholar
  14. 14.
    Hiki N, Sano T, Fukunaga T, Ohyama S, Tokunaga M, Yamaguchi T (2009) Survival benefit of pylorus-preserving gastrectomy in early gastric cancer. J Am Coll Surg 209:297–301PubMedCrossRefGoogle Scholar
  15. 15.
    Japanese Gastric Cancer A (1998) Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1:10–24CrossRefGoogle Scholar
  16. 16.
    Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, Bae JM (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 15:1625–1631PubMedCrossRefGoogle Scholar
  17. 17.
    Ikeguchi M, Hatada T, Yamamoto M, Miyake T, Matsunaga T, Fukuda K, Saito H, Tatebe S (2010) Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach. Surg Today 40:228–233PubMedCrossRefGoogle Scholar
  18. 18.
    Horiuchi T, Shimomatsuya T, Chiba Y (2001) Laparoscopically assisted pylorus-preserving gastrectomy. Surg Endosc 15:325–328PubMedCrossRefGoogle Scholar
  19. 19.
    Nakamura T, Onozato W, Mitomi H, Naito M, Sato T, Ozawa H, Hatate K, Ihara A, Watanabe M (2009) Retrospective, matched case-control study comparing the oncologic outcomes between laparoscopic surgery and open surgery in patients with right-sided colon cancer. Surg Today 39:1040–1045PubMedCrossRefGoogle Scholar
  20. 20.
    Fukagawa T, Katai H, Saka M, Morita S, Sano T, Sasako M (2009) Gallstone formation after gastric cancer surgery. J Gastrointest Surg 13:886–889PubMedCrossRefGoogle Scholar
  21. 21.
    Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) Functional evaluation after vagus-nerve-sparing laparoscopically assisted distal gastrectomy. Surg Endosc 22:2003–2008PubMedCrossRefGoogle Scholar
  22. 22.
    Naito H, Shibata C, Ohtani N, Funayama Y, Fukushima K, Matsuno S, Sasaki I (2002) Pylorus-preserving gastrectomy: effect on resistance through the sphincter of Oddi compared to conventional distal gastrectomy in dogs. World J Surg 26:602–607PubMedCrossRefGoogle Scholar
  23. 23.
    Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M (2008) Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 95:1131–1135PubMedCrossRefGoogle Scholar
  24. 24.
    Shimoyama S, Mafune K, Kaminishi M (2003) Indications for a pylorus-preserving gastrectomy for gastric cancer with proper muscle invasion. Arch Surg 138:1235–1239PubMedCrossRefGoogle Scholar
  25. 25.
    Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S (2010) Recurrence after curative resection of early gastric cancer. Ann Surg Oncol 17:448–454PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Xiaohua Jiang
    • 1
    • 2
  • Naoki Hiki
    • 1
  • Souya Nunobe
    • 1
  • Tetsu Fukunaga
    • 1
  • Koshi Kumagai
    • 1
  • Kyoko Nohara
    • 1
  • Hiroshi Katayama
    • 1
  • Shigekazu Ohyama
    • 1
  • Takeshi Sano
    • 1
  • Toshiharu Yamaguchi
    • 1
  1. 1.Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
  2. 2.Department of General SurgeryZhongda Hospital, Southeast UniversityNanjingChina

Personalised recommendations