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Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach

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Abstract

Purpose

Patients diagnosed with early gastric cancer located in the middle third of the stomach have two major surgical options, namely a conventional distal gastrectomy with Billroth I anastomosis (DG) or a pylorus-preserving gastrectomy (PPG). Pyloruspreserving gastrectomy is thought to have greater functional benefits than DG, but the evaluation of its prognosis and outcome has so far been insufficient.

Methods

Between 1997 and 2007, 133 patients were diagnosed with early gastric cancer located in the middle third of the stomach. Distal gastrectomy was performed in 87 and PPG was performed in 46 of these patients. The clinicopathological characteristics were compared between the groups.

Results

There were fewer dissected lymph nodes in PPG (mean: 21.9) than in DG (mean: 30.4, P = 0.001). Complications were detected in 16.1% of DG patients and in 6.5% of PPG patients. The occurrence of stasis after PPG (6.5%) was similar to that observed after DG (6.9%). One patient in the DG group died from cancer recurrence, but cancer recurrence was not detected in the PPG group. Although the difference was not significant, the overall 5-year survival rate in the 46 PPG patients (95%) was better than that in the 87 DG patients (86%, P = 0.087).

Conclusions

Pylorus-preserving gastrectomy patients had fewer postoperative complications than DG patients. The long-term follow-up of these patients will clarify the nutritional and prognostic benefits of PPG.

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References

  1. Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery 1967;61:838–845.

    CAS  PubMed  Google Scholar 

  2. Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 2008;95:1131–1135.

    Article  CAS  PubMed  Google Scholar 

  3. Kodama M, Koyama K. Indications for pylorus preserving gastrectomy for early gastric cancer located in the middle third of the stomach. World J Surg 1991;15:628–634.

    Article  CAS  PubMed  Google Scholar 

  4. Isozaki H, Okajima K, Momura E, Ichinona T, Fujii K, Izumi N, et al. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 1996;83:266–269.

    Article  CAS  PubMed  Google Scholar 

  5. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1998;1:10–24.

    Article  PubMed  Google Scholar 

  6. Zhang D, Shimoyama S, Kaminishi M. Feasibility of pyloruspreserving gastrectomy with a wider scope of lymphadenectomy. Arch Surg 1998;133:993–997.

    Article  CAS  PubMed  Google Scholar 

  7. Nakane Y, Akehira K, Inoue K, Iiyama H, Sato M, Masuya Y, et al. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Hepatogastroenterology 2000;47:590–595.

    CAS  PubMed  Google Scholar 

  8. Shibata C, Shiiba KI, Funayama Y, Ishii S, Fukushima K, Mizoi T, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg 2004;28:857–861.

    Article  PubMed  Google Scholar 

  9. Tomita R, Takizawa H, Tanjoh K. Physiologic effects of cisapride on gastric emptying after pylorus-preserving gastrectomy for early gastric cancer. World J Surg 1998;22:35–41.

    Article  CAS  PubMed  Google Scholar 

  10. Michiura T, Nakane Y, Kanbara T, Nakai K, Inoue K, Yamamichi K, et al. Assessment of the preserved function of the remnant stomach in pylorus-preserving gastrectomy by gastric emptying scintigraphy. World J Surg 2006;30:1277–1283.

    Article  PubMed  Google Scholar 

  11. Park DJ, Lee H-J, Jung HC, Kim WH, Lee KU, Yang H-K. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 2008;32:1029–1036.

    Article  Google Scholar 

  12. Yamaguchi T, Ichikawa D, Kurioka H, Ikoma H, Koike H, Otsuji E, et al. Postoperative clinical evaluation following pyloruspreserving gastrectomy. Hepatogastroenterology 2004;51:883–886.

    PubMed  Google Scholar 

  13. Imada T, Rino Y, Takahashi M, Hatori S, Tanaka J, Shiozawa M, et al. Gastric emptying after pylorus-preserving gastrectomy in comparison with conventional subtotal gastrectomy for early gastric carcinoma. Surg Today 1998;28:135–138.

    Article  CAS  PubMed  Google Scholar 

  14. Imada T, Rino Y, Takahashi M, Suzuki M, Tanaka J, Shiozawa M, et al. Postoperative functional evaluation of pyloruspreserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery 1998;123:165–170.

    CAS  PubMed  Google Scholar 

  15. Hotta T, Taniguchi K, Kobayashi Y, Johata K, Sahara M, Naka T, et al. Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer. Surg Today 2001;31:774–779.

    Article  CAS  PubMed  Google Scholar 

  16. Nakabayashi T, Mochiki E, Garcia M, Haga N, Suzuki T, Asao T, et al. Pyloric motility after pylorus-preserving gastrectomy with or without the pyloric branch of the vagus nerve. World J Surg 2002;26:577–583.

    Article  PubMed  Google Scholar 

  17. Phillips RJ, Baronowsky EA, Powley TL. Afferent innervation of gastrointestinal tract smooth muscle by the hepatic branch of the vagus. J Comp Neurol 1997;384:248–270.

    Article  CAS  PubMed  Google Scholar 

  18. Nomura E, Isozaki H, Fujii K, Toyoda M, Niki M, Sako S, et al. Postoperative evaluation of function-preserving gastrectomy for early gastric cancer. Hepatogastroenterology 2003;50:2246–2250.

    PubMed  Google Scholar 

  19. Tomita R, Tanjoh K, Fujisaki S. Novel operative technique for vagal nerve- and pyloric sphincter-preserving distal gastrectomy reconstructed by interposition of a 5 cm jejunal J pouch with a 3 cm jejunal conduit for early gastric cancer and postoperative quality of life 5 years after operation. World J Surg 2004;28:766–774.

    Article  PubMed  Google Scholar 

  20. Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y, et al. Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer 1992;70:1030–1037.

    Article  CAS  PubMed  Google Scholar 

  21. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol 2006;13:363–369.

    Article  PubMed  Google Scholar 

  22. Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg 2007;24:96–100.

    Article  PubMed  Google Scholar 

  23. Shim JH, Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population. Surg Today 2009;39:481–486.

    Article  PubMed  Google Scholar 

  24. Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M. Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 2006;203:162–169.

    Article  PubMed  Google Scholar 

  25. Nunobu S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, et al. Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg 2007;31:2335–2340.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan

    Masahide Ikeguchi, Tomoko Hatada, Manabu Yamamoto, Takanori Miyake, Tomonori Matsunaga, Kenji Fukuda, Hiroaki Saito & Shigeru Tatebe

Authors
  1. Masahide Ikeguchi
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  2. Tomoko Hatada
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  3. Manabu Yamamoto
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  4. Takanori Miyake
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  5. Tomonori Matsunaga
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  6. Kenji Fukuda
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  7. Hiroaki Saito
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  8. Shigeru Tatebe
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Ikeguchi, M., Hatada, T., Yamamoto, M. et al. 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 (2010). https://doi.org/10.1007/s00595-009-4043-4

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  • DOI: https://doi.org/10.1007/s00595-009-4043-4

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