Abstract
Background
Since the early 1990s, pylorus-preserving gastrectomy (PPG) has been used in the treatment of patients with early gastric cancer in order to reduce postprandial symptoms. To date, there have been few reports of long-term symptom evaluation following this procedure. The aim of this study was to evaluate long-term postoperative outcomes after PPG.
Methods
Three hundred and ninety-seven patients with early gastric cancer were enrolled in this study: 194 patients who underwent PPG and 203 who underwent distal gastrectomy with Billroth-I reconstruction (DGBI). We compared the symptoms for the two groups in a questionnaire on postoperative functional outcomes, endoscopy findings and the appearance of gallstones after surgery.
Results
The incidence of symptoms suggesting early dumping syndrome was significantly lower in the PPG group compared with the DGBI group (P < 0.05). The incidences of disturbed bowel habit and frequent flatus were significantly lower in the PPG than in the DGBI group. The average relative body weight (actual BW/ BW immediately before the surgery) was significantly better in the PPG than in the DGBI group (P < 0.001).
Conclusion
The long-term results show that PPG has clear advantages over DGBI in terms of postoperative symptoms and functional outcomes. These results imply that PPG should be the recommended procedure for early gastric cancers located in the middle third of the stomach.
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Y Moriwaki C Kunisaki S Kobayashi H Harada S Imai Y Kido et al. (2003) ArticleTitleProgressive improvement of prognosis for patients with gastric cancer (dynamic stage grouping) with increasing survival interval from initial staging: how much longer can a given survivor expect to live? Surgery 133 135–40 Occurrence Handle12605173 Occurrence Handle10.1067/msy.2003.95
Y Kodera Y Yamamura Y Kanemitsu Y Shimizu T Hirai K Yasui et al. (2001) ArticleTitleLymph node metastasis in cancer of the middle-third stomach: criteria for treatment with a pylorus-preserving gastrectomy Surg Today 31 196–203 Occurrence Handle11318120 Occurrence Handle10.1007/s005950170168 Occurrence Handle1:STN:280:DC%2BD3MvjsV2jtA%3D%3D
H Higashi S Natsugoe S Ishigami Y Uenosono M Matsumoto A Nakajo et al. (2003) ArticleTitleDistribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasion World J Surg 27 455–9 Occurrence Handle12658492 Occurrence Handle10.1007/s00268-002-6601-4
Y Maehara Y Kakeji S Oda I Takahashi K Akazawa K Sugimachi (2000) ArticleTitleTime trends of surgical treatment and the prognosis for Japanese patients with gastric cancer Br J Cancer 83 986–91 Occurrence Handle10993643 Occurrence Handle10.1054/bjoc.2000.1427 Occurrence Handle1:STN:280:DC%2BD3M%2FhvVOruw%3D%3D
Y Adachi N Shiraishi A Shiromizu T Bandoh M Aramaki S Kitano (2000) ArticleTitleLaparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy Arch Surg 135 806–10 Occurrence Handle10896374 Occurrence Handle10.1001/archsurg.135.7.806 Occurrence Handle1:STN:280:DC%2BD3czltlaksg%3D%3D
H Osugi K Fukuhara N Takada H Takemura H Kinoshita (2004) ArticleTitleReconstructive procedure after distal gastrectomy to prevent remnant gastritis Hepatogastroenterology 51 1215–8 Occurrence Handle15239282 Occurrence Handle1:STN:280:DC%2BD2czjslWktg%3D%3D
T Gotoda A Yanagisawa M Sasako H Ono Y Nakanishi T Shimoda et al. (2000) ArticleTitleIncidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers Gastric Cancer 3 219–25 Occurrence Handle11984739 Occurrence Handle10.1007/PL00011720
RM Soetikno T Gotoda Y Nakanishi N Soehendra (2003) ArticleTitleEndoscopic mucosal resection Gastrointest Endosc 57 567–79 Occurrence Handle12665775 Occurrence Handle10.1067/mge.2003.130
T Maki T Shiratori T Hatafuku K Sugawara (1967) ArticleTitlePylorus-preserving gastrectomy as an improved operation for gastric ulcer Surgery 61 838–42 Occurrence Handle5338114 Occurrence Handle1:STN:280:DyaF2s7msFSitg%3D%3D
M Kodama K Koyama T Chida A Arakawa T Gennady (1995) ArticleTitleEarly postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer World J Surg 19 456–61 Occurrence Handle7639006 Occurrence Handle10.1007/BF00299190 Occurrence Handle1:STN:280:DyaK2Mzms1aitA%3D%3D
Y Nakae K Akehira K Inoue H Iiyama M Sato Y Masuya et al. (2000) ArticleTitlePostoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer Hepatogastroenterology 47 590–5
T Imada Y Rino M Takahashi M Suzuki J Tanaka M Shiozawa et al. (1998) ArticleTitlePostoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy Surgery 123 165–70 Occurrence Handle9481402 Occurrence Handle1:STN:280:DyaK1c7kt1Cjsw%3D%3D
T Yamaguchi D Ichikawa H Kurioka H Ikoma H Koike E Otsuji et al. (2004) ArticleTitlePostoperative clinical evaluation following pylorus-preserving gastrectomy Hepatogastroenterology 51 883–6 Occurrence Handle15143939
K Nishikawa H Kawahara T Yumiba T Nishida Y Inoue T Ito et al. (2002) ArticleTitleFunctional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy for early gastric cancer Surgery 131 613–24 Occurrence Handle12075173 Occurrence Handle10.1067/msy.2002.124630
K Sawai T Takahashi T Fujioka H Minato H Taniguchi T Yamaguchi (1995) ArticleTitlePylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variations of the infrapyloric artery Am J Surg 170 285–8 Occurrence Handle7661298 Occurrence Handle10.1016/S0002-9610(05)80015-7 Occurrence Handle1:STN:280:DyaK2MzptVertQ%3D%3D
H Isozaki K Okajima E Momura T Ichinona K Fujii N Izumi et al. (1996) ArticleTitlePostoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer Br J Surg 83 266–9 Occurrence Handle8689185 Occurrence Handle10.1002/bjs.1800830239 Occurrence Handle1:STN:280:DyaK283ks12rtQ%3D%3D
T Hotta K Taniguchi Y Kobayashi K Johata M Sahara T Naka et al. (2001) ArticleTitlePostoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer Surg Today 31 774–9 Occurrence Handle11686554 Occurrence Handle10.1007/s005950170046 Occurrence Handle1:STN:280:DC%2BD3MnhtF2htw%3D%3D
R Tomita S Fujisaki K Tanjoh (2003) ArticleTitlePathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer World J Surg 27 725–33 Occurrence Handle12734683 Occurrence Handle10.1007/s00268-003-6906-y
C Shibata K Shiiba Y Funayama S Ishii K Fukushima T Mizoi et al. (2004) ArticleTitleOutcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial World J Surg 28 857–61 Occurrence Handle15593456 Occurrence Handle10.1007/s00268-004-7369-5
InstitutionalAuthorNameJapanese Gastric Cancer Association (1998) ArticleTitleJapanese classification of gastric carcinoma. Second English edition Gastric Cancer 1 10–24 Occurrence Handle11957040 Occurrence Handle10.1007/PL00011681
F Nagao S Hayashi Y Yamaguchi T Shiratori T Ohkubo K Okajima et al. (1972) ArticleTitleSymposium “Early dumping syndrome Jpn J Gastroenterol Surg 4 1–20
M Kubo M Sasako T Gotoda H Ono M Fujishiro D Saito et al. (2002) ArticleTitleEndoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification Gastric Cancer 5 83–9 Occurrence Handle12111583 Occurrence Handle10.1007/s101200200014
K Matsumoto Y Uchida T Noguchi T Hashimoto Y Hiraoka N Kubo (1997) ArticleTitleA device in reconstruction method after distal gastrectomy: special reference to double tract method with jejunal pouch J Jpn Surg Soc 98 565–70 Occurrence Handle1:STN:280:DyaK2szpvFOjuw%3D%3D
BJ Kim T O'Connell (1999) ArticleTitleGastroduodenostomy after gastric resection for cancer Am Surg 65 905–7 Occurrence Handle10515531 Occurrence Handle1:STN:280:DyaK1MvktlGmtg%3D%3D
JO Svensson (1983) ArticleTitleDuodenogastric reflux after gastric surgery Scand J Gastroenterol 18 729–34 Occurrence Handle6669936 Occurrence Handle1:STN:280:DyaL2c7ks1CqsQ%3D%3D Occurrence Handle10.3109/00365528309182087
K Fukuhara H Osugi N Takada M Takemura M Higashino H Kinoshita (2002) ArticleTitleReconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux World J Surg 26 1452–7 Occurrence Handle12370787 Occurrence Handle10.1007/s00268-002-6363-z
T Nabae S Takahashi H Konomi ZL Deng K Yokohata K Chijiiwa et al. (2001) ArticleTitleEffect of prepyloric gastric transection and anastomosis on sphincter of Oddi cyclic motility in conscious dogs J Gastroenterol 36 530–7 Occurrence Handle11519831 Occurrence Handle10.1007/s005350170055 Occurrence Handle1:STN:280:DC%2BD3Mvns1ekug%3D%3D
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Nunobe, S., Sasako, M., Saka, M. et al. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer 10, 167–172 (2007). https://doi.org/10.1007/s10120-007-0434-7
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DOI: https://doi.org/10.1007/s10120-007-0434-7