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Preventive effect on delayed gastric emptying of preserving the infra-pyloric vein in laparoscopic pylorus-preserving gastrectomy for early gastric cancer

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Abstract

Background

Pylorus-preserving gastrectomy (PPG) has the postoperative advantages of a better quality of life and less weight loss than distal gastrectomy. However, postoperative delayed gastric emptying (DGE) due to antral hypomotility can be a problem. Although preserving the infra-pyloric vein (IPV) is reported to improve congestion of the antrum and prevent DGE, the benefits of this procedure have not been confirmed. The present study aimed to clarify the preventive effect on DGE of preserving the IPV.

Methods

A total of 148 patients [IPV-preserved (IPVP): 78 patients and IPV-non-preserved (IPVN): 70 patients] who underwent laparoscopic and robotic PPG (LRPPG) for early gastric cancer were enrolled in this study. The clinicopathologic characteristics and incidence of DGE were compared between the groups. The nutritional risk index (NRI) at 1, 2, and 3 years after the operation and the relapse-free survival (RFS) were also compared.

Results

There were no significant differences in the clinicopathological characteristics between the two groups. DGE was observed in 15 of 148 patients (10.1%). The incidence of DGE did not differ markedly between the 2 groups (IPVP vs. IPVN; 11.5% vs. 8.6% p = 0.596). There were no significant differences in other complications between the groups either (IPVP vs. IPVN; 19.2% vs. 21.4%; p = 0.838). The NRI and 3-year RFS were not significantly different between the two groups.

Conclusion

Regarding LRPPG, preserving the IPV did not help prevent DGE and resulted in no significant difference in the outcomes.

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Acknowledgement

We are grateful to Dr. Naotake Yanagisawa for his help in the statistical analyses, particularly propensity score matching.

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Authors and Affiliations

  1. Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Sanae Kaji, Rie Makuuchi, Tomoyuki Irino, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Hayato Omori, Keiichi Fujiya, Noriyuki Nishiwaki, Kenichiro Furukawa, Kenichi Nakamura, Yusuke Koseki, Yuhei Waki, Raito Asaoka & Masanori Terashima

  2. Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan

    Sanae Kaji

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  1. Sanae Kaji
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Correspondence to Masanori Terashima.

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Sanae Kaji, Rie Makuuchi, Tomoyuki Irino, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Hayato Omori, Keiichi Fujiya, Noriyuki Nishiwaki, Kenichiro Furukawa, Kenichi Nakamura, Yusuke Koseki, Yuhei Waki, Raito Asaoka, and Masanori Terashima have no conflict of interest or financial ties to disclose.

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Kaji, S., Makuuchi, R., Irino, T. et al. Preventive effect on delayed gastric emptying of preserving the infra-pyloric vein in laparoscopic pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc 34, 3853–3860 (2020). https://doi.org/10.1007/s00464-019-07151-9

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