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Gastric Cancer

, Volume 10, Issue 3, pp 167–172 | Cite as

Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

  • Souya Nunobe
  • Mitsuru Sasako
  • Makoto Saka
  • Takeo Fukagawa
  • Hitosho Katai
  • Takeshi Sano
Original article

Abstract

Background

Since the early 1990s, pylorus-preserving gastrectomy (PPG) has been used in the treatment of patients with early gastric cancer in order to reduce postprandial symptoms. To date, there have been few reports of long-term symptom evaluation following this procedure. The aim of this study was to evaluate long-term postoperative outcomes after PPG.

Methods

Three hundred and ninety-seven patients with early gastric cancer were enrolled in this study: 194 patients who underwent PPG and 203 who underwent distal gastrectomy with Billroth-I reconstruction (DGBI). We compared the symptoms for the two groups in a questionnaire on postoperative functional outcomes, endoscopy findings and the appearance of gallstones after surgery.

Results

The incidence of symptoms suggesting early dumping syndrome was significantly lower in the PPG group compared with the DGBI group (P < 0.05). The incidences of disturbed bowel habit and frequent flatus were significantly lower in the PPG than in the DGBI group. The average relative body weight (actual BW/ BW immediately before the surgery) was significantly better in the PPG than in the DGBI group (P < 0.001).

Conclusion

The long-term results show that PPG has clear advantages over DGBI in terms of postoperative symptoms and functional outcomes. These results imply that PPG should be the recommended procedure for early gastric cancers located in the middle third of the stomach.

Key words

Pylorus-preserving gastrectomy Postoperative evaluation Dumping syndrome 

References

  1. 1.
    Moriwaki, Y, Kunisaki, C, Kobayashi, S, Harada, H, Imai, S, Kido, Y,  et al. 2003Progressive improvement of prognosis for patients with gastric cancer (dynamic stage grouping) with increasing survival interval from initial staging: how much longer can a given survivor expect to live?Surgery13313540PubMedCrossRefGoogle Scholar
  2. 2.
    Kodera, Y, Yamamura, Y, Kanemitsu, Y, Shimizu, Y, Hirai, T, Yasui, K,  et al. 2001Lymph node metastasis in cancer of the middle-third stomach: criteria for treatment with a pylorus-preserving gastrectomySurg Today31196203PubMedCrossRefGoogle Scholar
  3. 3.
    Higashi, H, Natsugoe, S, Ishigami, S, Uenosono, Y, Matsumoto, M, Nakajo, A,  et al. 2003Distribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasionWorld J Surg274559PubMedCrossRefGoogle Scholar
  4. 4.
    Maehara, Y, Kakeji, Y, Oda, S, Takahashi, I, Akazawa, K, Sugimachi, K 2000Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancerBr J Cancer8398691PubMedCrossRefGoogle Scholar
  5. 5.
    Adachi, Y, Shiraishi, N, Shiromizu, A, Bandoh, T, Aramaki, M, Kitano, S 2000Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomyArch Surg13580610PubMedCrossRefGoogle Scholar
  6. 6.
    Osugi, H, Fukuhara, K, Takada, N, Takemura, H, Kinoshita, H 2004Reconstructive procedure after distal gastrectomy to prevent remnant gastritisHepatogastroenterology5112158PubMedGoogle Scholar
  7. 7.
    Gotoda, T, Yanagisawa, A, Sasako, M, Ono, H, Nakanishi, Y, Shimoda, T,  et al. 2000Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centersGastric Cancer321925PubMedCrossRefGoogle Scholar
  8. 8.
    Soetikno, RM, Gotoda, T, Nakanishi, Y, Soehendra, N 2003Endoscopic mucosal resectionGastrointest Endosc5756779PubMedCrossRefGoogle Scholar
  9. 9.
    Maki, T, Shiratori, T, Hatafuku, T, Sugawara, K 1967Pylorus-preserving gastrectomy as an improved operation for gastric ulcerSurgery6183842PubMedGoogle Scholar
  10. 10.
    Kodama, M, Koyama, K, Chida, T, Arakawa, A, Gennady, T 1995Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancerWorld J Surg1945661PubMedCrossRefGoogle Scholar
  11. 11.
    Nakae, Y, Akehira, K, Inoue, K, Iiyama, H, Sato, M, Masuya, Y,  et al. 2000Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancerHepatogastroenterology475905Google Scholar
  12. 12.
    Imada, T, Rino, Y, Takahashi, M, Suzuki, M, Tanaka, J, Shiozawa, M,  et al. 1998Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomySurgery12316570PubMedGoogle Scholar
  13. 13.
    Yamaguchi, T, Ichikawa, D, Kurioka, H, Ikoma, H, Koike, H, Otsuji, E,  et al. 2004Postoperative clinical evaluation following pylorus-preserving gastrectomyHepatogastroenterology518836PubMedGoogle Scholar
  14. 14.
    Nishikawa, K, Kawahara, H, Yumiba, T, Nishida, T, Inoue, Y, Ito, T,  et al. 2002Functional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy for early gastric cancerSurgery13161324PubMedCrossRefGoogle Scholar
  15. 15.
    Sawai, K, Takahashi, T, Fujioka, T, Minato, H, Taniguchi, H, Yamaguchi, T 1995Pylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variations of the infrapyloric arteryAm J Surg1702858PubMedCrossRefGoogle Scholar
  16. 16.
    Isozaki, H, Okajima, K, Momura, E, Ichinona, T, Fujii, K, Izumi, N,  et al. 1996Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancerBr J Surg832669PubMedCrossRefGoogle Scholar
  17. 17.
    Hotta, T, Taniguchi, K, Kobayashi, Y, Johata, K, Sahara, M, Naka, T,  et al. 2001Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancerSurg Today317749PubMedCrossRefGoogle Scholar
  18. 18.
    Tomita, R, Fujisaki, S, Tanjoh, K 2003Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancerWorld J Surg2772533PubMedCrossRefGoogle Scholar
  19. 19.
    Shibata, C, Shiiba, K, Funayama, Y, Ishii, S, Fukushima, K, Mizoi, T,  et al. 2004Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trialWorld J Surg2885761PubMedCrossRefGoogle Scholar
  20. 20.
    Japanese Gastric Cancer Association1998Japanese classification of gastric carcinoma. Second English editionGastric Cancer11024PubMedCrossRefGoogle Scholar
  21. 21.
    Nagao, F, Hayashi, S, Yamaguchi, Y, Shiratori, T, Ohkubo, T, Okajima, K,  et al. 1972Symposium “Early dumping syndromeJpn J Gastroenterol Surg4120Google Scholar
  22. 22.
    Kubo, M, Sasako, M, Gotoda, T, Ono, H, Fujishiro, M, Saito, D,  et al. 2002Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classificationGastric Cancer5839PubMedCrossRefGoogle Scholar
  23. 23.
    Matsumoto, K, Uchida, Y, Noguchi, T, Hashimoto, T, Hiraoka, Y, Kubo, N 1997A device in reconstruction method after distal gastrectomy: special reference to double tract method with jejunal pouchJ Jpn Surg Soc9856570Google Scholar
  24. 24.
    Kim, BJ, O'Connell, T 1999Gastroduodenostomy after gastric resection for cancerAm Surg659057PubMedGoogle Scholar
  25. 25.
    Svensson, JO 1983Duodenogastric reflux after gastric surgeryScand J Gastroenterol1872934PubMedCrossRefGoogle Scholar
  26. 26.
    Fukuhara, K, Osugi, H, Takada, N, Takemura, M, Higashino, M, Kinoshita, H 2002Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal refluxWorld J Surg2614527PubMedCrossRefGoogle Scholar
  27. 27.
    Nabae, T, Takahashi, S, Konomi, H, Deng, ZL, Yokohata, K, Chijiiwa, K,  et al. 2001Effect of prepyloric gastric transection and anastomosis on sphincter of Oddi cyclic motility in conscious dogsJ Gastroenterol365307PubMedCrossRefGoogle Scholar

Copyright information

© International and Japanese Gastric Cancer Association 2007

Authors and Affiliations

  • Souya Nunobe
    • 1
  • Mitsuru Sasako
    • 1
  • Makoto Saka
    • 1
  • Takeo Fukagawa
    • 1
  • Hitosho Katai
    • 1
  • Takeshi Sano
    • 1
  1. 1.Department of SurgeryNational Cancer Center HospitalTokyoJapan

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