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

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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.

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  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 83:986–991

    Article  PubMed  CAS  Google Scholar 

  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 184:373–377

    PubMed  CAS  Google Scholar 

  3. Sano T, Hollowood A (2006) Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg 95:249–255

    PubMed  CAS  Google Scholar 

  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 28:857–861

    Article  PubMed  Google Scholar 

  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 32:1029–1036

    Article  PubMed  Google Scholar 

  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 123:165–170

    Article  PubMed  CAS  Google Scholar 

  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 10:167–172

    Article  PubMed  Google Scholar 

  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 14:958–964

    Article  PubMed  Google Scholar 

  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 245:68–72

    Article  PubMed  Google Scholar 

  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 247:962–967

    Article  PubMed  Google Scholar 

  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 203:162–169

    Article  PubMed  Google Scholar 

  12. Hiki N, Kaminishi M (2005) Pylorus-preserving gastrectomy in gastric cancer surgery: open and laparoscopic approaches. Langenbecks Arch Surg 390:442–447

    Article  PubMed  Google Scholar 

  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 31:2335–2340

    Article  PubMed  Google Scholar 

  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 209:297–301

    Article  PubMed  Google Scholar 

  15. Japanese Gastric Cancer A (1998) Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1:10–24

    Article  Google Scholar 

  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 15:1625–1631

    Article  PubMed  Google Scholar 

  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 40:228–233

    Article  PubMed  Google Scholar 

  18. Horiuchi T, Shimomatsuya T, Chiba Y (2001) Laparoscopically assisted pylorus-preserving gastrectomy. Surg Endosc 15:325–328

    Article  PubMed  CAS  Google Scholar 

  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 39:1040–1045

    Article  PubMed  CAS  Google Scholar 

  20. Fukagawa T, Katai H, Saka M, Morita S, Sano T, Sasako M (2009) Gallstone formation after gastric cancer surgery. J Gastrointest Surg 13:886–889

    Article  PubMed  Google Scholar 

  21. Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) Functional evaluation after vagus-nerve-sparing laparoscopically assisted distal gastrectomy. Surg Endosc 22:2003–2008

    Article  PubMed  Google Scholar 

  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 26:602–607

    Article  PubMed  Google Scholar 

  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 95:1131–1135

    Article  PubMed  CAS  Google Scholar 

  24. Shimoyama S, Mafune K, Kaminishi M (2003) Indications for a pylorus-preserving gastrectomy for gastric cancer with proper muscle invasion. Arch Surg 138:1235–1239

    Article  PubMed  Google Scholar 

  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 17:448–454

    Article  PubMed  Google Scholar 

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Correspondence to Naoki Hiki.

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Jiang, X., Hiki, N., Nunobe, S. et al. Long-term outcome and survival with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc 25, 1182–1186 (2011).

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