Outcomes after Pylorus‐preserving Gastrectomy for Early Gastric Cancer: A Prospective Multicenter Trial

Abstract

The aim of the present study was to compare in a prospective, multicenter trial the results early and late after pylorus-preserving gastrectomy (PPG) versus conventional distal gastrectomy (CDG) with Billroth I anastomosis for early gastric cancer. Eighty-one patients with early gastric cancer were randomized and then underwent either PPG or CDG. Duration of operation, intraoperative blood loss, days until removal of the nasogastric tube, days until start of oral intake, and decrease in body weight were studied as parameters for outcomes early after the surgery. Late results were studied in patients followed for longer than 3 years. Change in body weight, status of oral intake, symptoms suggesting early dumping syndrome, and overall satisfaction were addressed in the questionnaire. The presence of gallstones was examined with ultrasonography. There were no differences in early results between PPG and CDG. The incidence of early dumping syndrome was lower in PPG (8%) than in CDG (33%). Other late results including the incidence of gallstones were not different between the 2 groups. These results indicate that PPG is as safe as CDG and has an advantage in terms of early dumping syndrome.

Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

“…Our study showed that the incidences of early dumping syndrome and postoperative body weight loss were signifi cantly lower in the PPG than in the DGBI group. Contrary to previous studies, the incidence of gastric stasis with PPG was the same as that with DGBI [19]. In the longterm, it may be important to preserve the vagal nerve for improved gastric emptying.…”

“…Although several reports have evaluated outcomes following limited resection, the number of cases has been small, with too short an observation period to offer defi nitive evidence of the superiority of these procedures [10][11][12][13][14][15][16][17][18][19].…”

Lymphadenectomy along the infrapyloric artery may be dispensable when performing pylorus-preserving gastrectomy for early middle-third gastric cancer

“…Clinically, T1N0 gastric cancer whose distal border is at least 4 cm proximal to the pylorus is a good indication for PPG [12]. This operation has an advantage over conventional distal gastrectomy, with a lower incidence of dumping syndrome, bile reflux gastritis, and nutritional deficit [13][14][15][16]. These advantages are attributable to preservation of the pyloric branch of the vagus nerve and the nutrient vessels supplying the antrum [17][18][19][20].…”

Nutritional Assessment of Patients After Pylorus-Preserving Gastrectomy for Early Gastric Cancer

“…Dumping symptoms were reported in 4-46% of DG patients, but only in 0-13% of PPG patients [8][9][10]. Hotta et al [11] reported that nutritional status and serum albumin and hemoglobin levels were better in PPG than in DG patients.…”