Length of the antral segment in pylorus-preserving gastrectomy

Nakane, Yasushi; Michiura, T; Inoue, K; Sato, M; Nakai, Kenta; Yamamichi, Keigo

doi:10.1046/j.0007-1323.2001.01984.x

Cited by 29 publications

(31 citation statements)

References 10 publications

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“…Another factor to influence the rate of DGE after PPG is the antrum cuff length. It has been reported that the incidence of DGE was 35.0% (7/20) in patients with an antral cuff length of 1.5 cm and only 10.0% (1/10) in patients with an antral cuff length of 2.5 cm [40]. Nunobe et al [41] reported an incidence of DGE of 6-8% among 90 patients after PPG in whom the antral cuff length was maintained at 3 cm.…”

Section: Discussionmentioning

confidence: 98%

Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?

et al. 2019

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Background Pylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach. Methods We included all patients of the period 2013-2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postoperative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development.Results Overall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p < 0.001), less blood loss (p = 0.002) and lower postoperative morbidity compared to TG. For lymph-node (LN) stations being resected in all groups, no difference was found in number of resected LN. Recurrence-free survival was similar for all groups. PPG showed advantages regarding postoperative body weight, hemoglobin, total protein, albumin in postoperative 6 and 12 month follow-up. Lowest decrease of abdominal fat area after 12 months was seen for PPG. Gallstone incidence was significantly lower after PPG compared to TG (p < 0.001). Conclusions For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.

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Section: Discussionmentioning

confidence: 98%

Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?

et al. 2019

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“…The study included all patients with EGC in the middle third of the stomach diagnosed before surgery, excluding those who were candidates for endoscopic mucosal resection (EMR)10. Current recommendations for EMR are tumours confined to the mucosal layer, type I, IIa or depressed type IIc with no ulcer or ulcer scar (no fold convergence endoscopically), well or moderately differentiated adenocarcinomas, and tumours smaller than 2·0 cm (the distance between the distal transection line and the pyloric ring should be more than 2·5 cm because the remnant pyloric antrum must have a certain capacity for peristalsis to occur and move gastric contents into the duodenum11).…”

Section: Methodsmentioning

confidence: 99%

Outcome of pylorus-preserving gastrectomy for early gastric cancer

Morita¹,

Katai²,

Saka³

et al. 2008

British Journal of Surgery

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“…where the remaining 1.5cm antral portion is transected in Maki's fashion [1,2,[6][7][8][9][10]. However, Nakane et al [17] demonstrated the advantage of PPG involving a transection 2.5 cm proximal to the pylorus. The advantage of this approach, compared with a 1.5-cm transection, is evident in improved postprandial symptoms, food intake, body-weight recovery, and gastric emptying.…”

Section: Degree Of Residual Gastritis Amount Of Diet Residuementioning

confidence: 99%

The endoscopic evaluation of gastritis, gastric remnant residue, and the incidence of secondary cancer after pylorus-preserving and transverse gastrectomies

et al. 2004

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PPG and TrG have the advantage over DSG in preventing postoperative gastritis in the gastric remnant. On the other hand, moderate or greater diet residue in the gastric remnant is more common after PPG or TrG than after DSG. For the risk of carcinogenesis in the remnant gastric mucosa, we could not conclude that there was any apparent difference between these range-limited gastrectomies and conventional DSG. Further study is necessary to determine the significant advantages and disadvantages of using PPG or TrG.

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Length of the antral segment in pylorus-preserving gastrectomy

Abstract: Group 2 was superior to group 1 in terms of postprandial symptoms, food intake, recovery of body-weight and gastric emptying. The length of the retained antrum may play an important role in the motility of the pyloric ring following PPG.

Cited by 29 publications

References 10 publications

Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?

Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?

Outcome of pylorus-preserving gastrectomy for early gastric cancer

The endoscopic evaluation of gastritis, gastric remnant residue, and the incidence of secondary cancer after pylorus-preserving and transverse gastrectomies

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