Abstract
Background
To clarify the significance of preserving pyloric and hepatic branches of the vagal nerve (PHV) after pylorus preserving distal gastrectomy (PPG) for early gastric cancer, the author investigated the postgastrectomy syndrome and gastric emptying function at 5 years in PPG patients with or without preserving the PHV.
Methods
A total of 18 subjects (mucosal cancers) who underwent PPG with D1 lymph node dissection and preserving the PHV; they comprised group A—12 men and 6 women aged 38–68 years (mean 58.9 years). They were interviewed to inquire about gastrointestinal symptom (appetite, weight loss, gastric fullness, reflux esophagitis, early dumping syndrome) and then were compared with 24 PPG patients (submucosal cancers) with D2 lymph node dissection without preserving the PHV (group B—16 men and 8 women aged 33 to 69 years, mean 60.1 years). Esophagogastric endoscopy, abdominal ultrasonography, and gastric emptying function tests (GET) were undertaken, the latter by both radioisotope (solid diet) and acetaminophen (liquid diet) methods.
Results
There were no differences in the postoperative gastrointestinal symptoms, endoscopic reflux esophagitis, or endoscopic mucosal edema and redness (gastropathy) between groups A and B. However, more cholecystolithiasis (gallbladder stones) was found in group A than in group B, with the difference being significant (P < 0.0391). The GET for solid diet and liquid diet were the almost same among groups A and B.
Conclusions
There were no significant differences in the postoperative QOL and GET between PPG patients with preserving PHV and those without preserving PHV. Cholecystolithiasis was only found in patients without preserving PHV.
Similar content being viewed by others
References
Kodama M, Koyama K, Chida T et al (1995) Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer. World J Surg 19:456–461
Isozaki H, Okajima K, Nomura E et al (1996) Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 83:266–269
Imada T, Rino Y, Takahashi M et al (1998) Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery 123:165–170
Tomita R, Takizawa H, Tanjoh K (1998) Physiologic effects of cisapride on gastric emptying after pylorus-preserving gastrectomy for early gastric cancer. World J Surg 22:35–41
Nakane Y, Akehira K, Inoue K et al (2000) Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Hepatogastroenterology 47:590–595
Tomita R, Fujisaki S, Tanjoh K (2003) Pathophysiological studies on the relationship between postogastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg 27:725–733
Tomita R, Koshinaga T, Ikeda T et al (2006) Duodenal interdigestive migrating motor complex in patients 5 years or more after pylorus-preserving gastrectomy for early gastric cancer. World J Surg 30:1459–1467
Nunobe S, Sasako M, Saka M et al (2007) Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer 10:167–172
Nishikawa K, Kawaharaq H, Yumiba T et al (2002) Functional characteristics of pylorus in patients undergoing pylorus-preserving gastrectomy for early gastric cancer. Surgery 131:613–624
Michiura T, Nakane Y, Kanbara T et al (2006) Assessment of the preserved function of the remnant stomach in pylorus-preserving gastrectomy by gastric emptying scintigraphy. World J Surg 30:1277–1283
Takahashi T, Endo S (2009) Effect of rikkunshito, a Chinese herbal medicine, on stasis in patients after pylorus-preserving gastrectomy. World J Surg 33:296–302
Christian PE, Datz FL, Sorenson JA (1983) Technical factors in gastric emptying studies. J Nucl Med 24:264–268
Matsuhisa T, Oshima H (1993) Gastric emptying function determination with acetaminophen method: results in upper gastrointestinal diseases. J Smooth Muscle Res 29:187–189
Mistiaen W, Van Hee R, Blockx P et al (2001) Gastric emptying rate for solid and for liquid test meals in patients with dyspeptic symptoms after partial gastrectomy and after vagotomy followed by partial gastrectomy. Hepatogastroenterology 48:299–302
Tomita R, Fujisaki S, Tanjoh K et al (2003) Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer. Am J Surg 185:354–359
Morita S, Katai H, Saka M et al (2008) Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 95:1429–1430
Sawai K, Takahashi T, Fujioka T et al (1995) Pylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variation of the infrapyloric artery. Am J Surg 170:285–288
Park D, Lee HJ, Jung HC et al (2008) Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 32:1029–1036
Shibata C, Sasaki I, Naito H et al (1995) Gastrointestinal motor activity after pylorus-preserving gastrectomy with or without vagotomy in dog. J Am Coll Surg 181:545–551
Mochiki E, Kuwano H, Nakabayashi T (2001) Pyloric relaxation regulated via intramural neural pathway of the antrum. Dig Dis Sci 46:2307–2313
Shimoyama K, Imamura K, Hiki N et al (2007) Nutritional comparisons between a pylorus-preserving gastrectomy with and without suprapyloric lymph node clearance: a preliminary report. Hepatogastroenterology 80:2401–2405
Nabae T, Takahashi S, Konomi H et al (2001) Effect of prepyloric gastric transection and anastomosis on sphincter of Oddi cyclic motility in conscious dogs. J Gastroenterol 36:530–537
Nakabayashi T, Mochiki E, Garcia M et al (2002) Pyloric motility after pylorus-preserving gastrectomy with or without the pyloric branch of the vagus nerve. World J Surg 26:577–583
Meyer JH, McGregor IL, Gueller R (1976) 99mTc-tagged chicken liver as a marker of solid food in human stomach. Dig Dis Sci 21:296–299
Hotta T, Taniguchi K, Kobayashi Y et al (2001) Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer. Surg Today 31:774–779
Forster J, Sarosiek I, Delocore R et al (2001) Gastric pacing is a new surgical treatment for gastroparesis. Am J Surg 182:676–678
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tomita, R. Gastric Emptying Function in Patients 5 Years After Pylorus-Preserving Distal Gastrectomy With or Without Preserving Pyloric and Hepatic Branches of the Vagal Nerve for Early Gastric Cancer. World J Surg 33, 2119–2126 (2009). https://doi.org/10.1007/s00268-009-0147-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-009-0147-7