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

Jiang, Xiaohua; Hiki, Naoki; Nunobe, Souya; Fukunaga, Tetsu; Kumagai, Koshi; Nohara, Kyoko; Katayama, Hiroshi; Ohyama, Shigekazu; Sano, Takeshi; Yamaguchi, Toshiharu

doi:10.1007/s00464-010-1336-z

Cited by 39 publications

(29 citation statements)

References 24 publications

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“…PPG has been reported as a safe and effective surgery in terms of nutritional advantage and a lower incidence of gallstone [17][18][19]. Better quality of life can be expected in patients who undergo these minimally invasive treatments compared with those who undergo TG with extensive lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

Influence of endoscopic submucosal dissection on additional gastric resections

et al. 2014

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Background Widespread application of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) results in noncurative resection in some patients. The influence of preceding ESD on additional gastric resections has not been completely evaluated. Methods Endoscopic, surgical, and pathological records of 255 patients who underwent additional gastrectomy after noncurative ESD at a single prefectural cancer center from September 2002 to December 2010 were reviewed. The estimated gastric resection based on endoscopic images before ESD was compared with the actual gastric resection performed after ESD. Results Altered gastric resection was performed in 4 (1.6 %) of the 255 patients. In 3 patients, total gastrectomy was performed instead of distal gastrectomy; in 1 patient, distal gastrectomy was performed instead of pylorus-preserving gastrectomy because of an insufficient distance from the cardia or pylorus caused by contraction of the ESD scar. Standard gastrectomy including total or distal gastrectomy with D2 lymph node dissection was performed in 33 patients because of deep submucosal invasion with positive/indefinite vertical margins. The final pathology revealed pT2 or deeper in 10 patients. Conclusions In conclusion, 98.4 % patients underwent the scheduled gastric resection before ESD, and the preceding gastric ESD had almost no influence on changing the gastric resection of the additional surgery. Although rare, the preceding ESD may necessitate alterations in gastric resection to widen the surgical area because of contraction of ESD scar for lesions near the cardia or pylorus. Mini abstract A retrospective study of additional gastrectomy after noncurative ESD showed that the preceding ESD had almost no influence on changing the gastric resection of the additional surgery.

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Section: Discussionmentioning

confidence: 99%

Influence of endoscopic submucosal dissection on additional gastric resections

et al. 2014

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“…A large number of surgeries involving gastrectomy with standard lymph node dissection have been carried out in South Korea and Japan (8,9). The results of randomized research allow us to conclude that gastrectomy has a number of advantages over conventional surgery; these are less blood loss and fewer complications, quicker patient recovery, fewer post-operative bed days, better visual effects, and almost the same 5-year survival rates at 57.3% vs. 58.9% (10)(11)(12).…”

Section: Minimally Invasive Treatment For Early Gcmentioning

confidence: 99%

Current practice for gastric cancer treatment in Ukraine

Sydiuk

2017

Transl. Gastroenterol. Hepatol.

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IntroductionGastric cancer (GC) is a significant and unsolved problem, despite a slight decrease in its morbidity. Globally, 952,000 new GC cases were registered in 2012. In South Korea and Japan, because of screening for GC, the 5-year survival rate is more than 60%. In most other countries, this value is 2-3 times lower (1,2). In Ukraine, GC is a serious problem. Annually, the country registers more than 8,000 new GC cases. The disease is usually diagnosed at stage III-IV (65% of cases) and 62.2% of patients die within 1 year. About 70% of patients with GC need chemotherapy, and for most of them, this is the only way to increase their life expectancy. Morbidity and death rateAccording to the national cancer register of Ukraine, there were 8,350 new cases of GC in 2014 (5,104 in men and 3,246 in women). Thus, the morbidity rate is 23.0 cases per 100,000 people (30.3 for men and 16.7 for women), which puts the disease in fourth place for men and eighth place for women for morbidity as a result of malignant tumors in Ukraine. During the period under investigation, 6,414 patients diagnosed with GC died. The death rate was 17.7 cases per 100,000 people (23.8 for men and 12.3 for women), which means that, for men and women respectively, GC has the second and third highest death rates from malignant tumors in Ukraine.People diagnosed with GC for the first time are diagnosed at the following stages according to the TNM classification: stage I-II, 37.6%; stage III, 22.5%; stage IV, 33.9%; and indistinct stage, 5%. Thus, advanced GC is diagnosed for the first time in as many as 60% of all patients, which leads to a high death rate of more than 50% during the first year.The above information allows us to conclude that the early diagnosis of GC, as well as combined methods of treating it with neo-adjuvant and adjuvant therapy, is of paramount importance in Ukraine.Despite the gradual decline in GC morbidity, there are still some serious associated problems. Namely, in the last 10 years, the following was noted ( Table 1): (I) very few changes in the morbidity rate for women; (II) decrease in the diagnosis of stage I-II disease in spite of the necessary endoscopic equipment; (III) high death rate within 1 year.Given this information, we should define the most of patients with GC need chemotherapy, and for most of them, this is the only way to increase their lifeexpectancy. An unsolved problem of nationwide importance is achieving the early diagnosis of GC, which predetermines the treatment outcome. The 5-year survival rate for GC patients in Ukraine is only 13%, while early diagnosed GC is almost totally curable using surgery. Another important task is the development of national diagnosis and treatment standards, which will be based on national breakthroughs and will meet modern international requirements.

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“…This procedure was carried out successfully as an alternative treatment for gastric ulcers in an attempt to prevent postoperative dumping syndrome and bile reflux, conditions that were often seen after conventional distal gastrectomy with a Billroth-I anastomosis [3][4][5][6]. To date, laparoscopy-assisted PPG (LAPPG) with a hand-sewn gastrogastrostomy performed through a mini-laparotomy has been used to treat EGC and its safety and feasibility have been reported [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes

et al. 2014

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Introduction The feasibility, safety, and improved quality of postoperative life following laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with a hand-sewn anastomosis via a mini-laparotomy for early gastric cancer (EGC) have been previously established. Here we describe the surgical procedure of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) using an intracorporeal delta-shaped anastomosis technique, and the short-term surgical outcomes of 60 patients with EGC in the middle stomach are reported. Methods After lymphadenectomy and mobilization of the stomach, intraoperative gastroscopy was performed in order to verify the location of the tumor, and then the distal and proximal transecting lines were established, 5 cm from the pyloric ring and just proximal to Demel's line, respectively. Following transection of the stomach, a deltashaped intracorporeal gastrogastrostomy was made with linear staplers. Results There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 259 min and 28 mL, respectively. Twelve patients (20.0 %) experienced postoperative complications classified as grade II using the Clavien-Dindo classification, with the most frequent complication being gastric stasis (6 cases, 10.0 %). The incidence of severe complications classified as grade III or above was 1.7 %; only one patient required reoperation and intensive care due to postoperative intraabdominal bleeding and subsequent multiple organ failure. Conclusion TLPPG with an intracorporeal delta-shaped anastomosis was found to be a safe procedure, although it tended to require a longer operating time than the wellestablished LAPPG with a hand-sewn gastrogastrostomy.

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

Abstract: 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.

Cited by 39 publications

References 24 publications

Influence of endoscopic submucosal dissection on additional gastric resections

Influence of endoscopic submucosal dissection on additional gastric resections

Current practice for gastric cancer treatment in Ukraine

Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes

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