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Incidence of Multiple Metachronous Gastric Cancers After Pyloric-Preserving Gastrectomy

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Abstract

Aim

Pylorus-preserving gastrectomy (PPG) is widely used for early gastric cancer located in the middle third of the stomach. The minimization of the extent of gastrectomy may increase the risk of metachronous multiple gastric cancer (MGC). We report the findings of a study that was conducted to evaluate the prevalence of MGC after PPG.

Methods

The clinical data of 533 patients who underwent PPG for gastric cancer between 1993 and 2018 were reviewed. The clinicopathological characteristics at the time of the primary treatment that were predictive of the development of MGC were explored. The median (range) observation period was 112.4 (8.1–290.7) months.

Results

Metachronous MGC was diagnosed in 33 of the 533 patients. The cumulative 5-year and 10-year event rates were 3.3% and 6.2%, respectively. The patient gender, presence/absence of synchronous MGC and the macroscopic type of the primary gastric cancer were significantly associated with the risk of development of metachronous MGC. Multivariate analysis identified the presence of synchronous MGC (hazard ratio [HR]: 4.828, 95% confidence interval [CI]; 1.611–12.30, p = 0.004) and Type 0-IIa primary gastric cancer (HR 2.810, 95% CI; 1.113–7.090, p = 0.029) as independent factors associated with the risk of development of MGC. All the patients could be treated by surgical or endoscopic resection for the metachronous MGC. Recurrence was observed in one patient.

Conclusions

There was quite a few incidence of development of metachronous MGC after PPG. Nevertheless, PPG remains reasonable treatment option, if adequate postoperative surveillance can be ensured.

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Authors and Affiliations

  1. Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3, Kawagishicho, Niigata City, Niigata, 951-8566, Japan

    Masaki Aizawa, Hiroshi Yabusaki, Atsushi Matsuki, Takeo Bamba & Satoru Nakagawa

Authors
  1. Masaki Aizawa
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  2. Hiroshi Yabusaki
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  3. Atsushi Matsuki
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  4. Takeo Bamba
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  5. Satoru Nakagawa
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Correspondence to Masaki Aizawa.

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The study was approved by the institutional reviewer board. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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Aizawa, M., Yabusaki, H., Matsuki, A. et al. Incidence of Multiple Metachronous Gastric Cancers After Pyloric-Preserving Gastrectomy. World J Surg 44, 2719–2727 (2020). https://doi.org/10.1007/s00268-020-05492-4

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  • DOI: https://doi.org/10.1007/s00268-020-05492-4

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