Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer

Isozaki, Hiroshi; Okajima, Kunio; Momura, E.; Ichinona, Tadashi; Fujii, Keizo; Izumi, Nobuyuki; Takeda, Yoshi

doi:10.1002/bjs.1800830239

Cited by 76 publications

(78 citation statements)

References 8 publications

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“…PPG is a modifi cation of distal gastrectomy, preserving 2-3 cm of the pyloric cuff, which maintains pyloric ring function. In a retrospective study, the incidences of dumping syndrome, biliary refl ux, and gallbladder stone formation were lower, and body weight recovery was better following PPG than after Billroth I reconstruction [71][72][73][74][75]. In a prospective randomized trial, only dumping syndrome was reduced [76].…”

Section: Pylorus-preserving Gastrectomymentioning

confidence: 99%

Lymph node dissection in the resection of gastric cancer: Review of existing evidence

Takeda

Terashima

2010

Gastric Cancer

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adjacent to the parts of the stomach removed-because of the absence of randomized controlled trials (RCTs) that favor D2 gastrectomy [4]. Theoretically, the removal of a wider range of LNs by extended LN dissection increases the chances for cure. In fact, the pattern of recurrence after extended surgery is completely different from that after limited surgery and involves locoregional recurrence in the majority of cases [5]. An extended LN dissection might have an infl uence on the locoregional recurrence rate. However, if the patients have already developed micrometastases or if no LNs are affected, such resection might be irrelevant and harmful, in terms of increased morbidity and mortality.In this review, we fi rst discuss the current status of the extent of LN dissection for advanced gastric cancer and offer an optimal management approach in view of the results of recent clinical trials.In contrast with results in patients with advanced gastric cancer, patients with early gastric cancer (EGC) have an excellent survival rate (>90%) after radical surgery [6,7]. Lymph node metastases from EGC are relatively infrequent, and metastases to group N2 are even rarer [8]. Therefore, it might be appropriate to perform less invasive surgery for EGC. In the latter part of this article, we review limited gastrectomy for EGC. Surgical anatomy of the gastric lymphaticsKnowledge of LN node staging is mandatory for understanding the ongoing debate regarding LN dissection. The very complex LNs of the stomach have been arranged into a very useful classifi cation by the Japanese Gastric Cancer Association (JGCA) [9]. According to this classifi cation, 16 different LN compartments (stations) are identifi ed surrounding the stomach. These LN stations are classifi ed into three groups that correspond to the location of the primary tumor and refl ect the likelihood of harboring metastases. Most perigastric LNs (stations 1-6) are defi ned as group N1, whereas the nodes along the left gastric (station 7), common hepatic Abstract Gastric cancer is one of the leading causes of cancer-related death worldwide. Surgery is the only curative therapy for localized gastric cancer, but the extent of regional lymphadenectomy has been a matter of considerable debate. Extended resections that are regarded as standard procedures in some Asian countries, including Japan and Korea, have not been shown to be as effective in Western countries. The extent of lymphadenectomy for advanced gastric cancer has been studied in many prospective randomized controlled trials. On the other hand, patients with early gastric cancer have an excellent survival rate (>90%) after radical surgery. Lymph node metastasis from early gastric cancer is relatively infrequent. Therefore, it might be practical to perform less invasive surgery for early gastric cancer. In this review article, we examine the evidence for lymph node dissection as radical surgery in advanced gastric cancer and the possibility of limited resection for early gastric cancer.

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Section: Pylorus-preserving Gastrectomymentioning

confidence: 99%

Lymph node dissection in the resection of gastric cancer: Review of existing evidence

Takeda

Terashima

2010

Gastric Cancer

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“…There are many studies reporting postoperative objective and subjective outcomes of pylorus-preserving gastrectomy, a subtype of transectional gastrectomy. To summarize, weight loss is less [40], dumping syndrome or early emptying occurs less frequently [41], regurgitant gastritis is milder [42,43], disturbed bowel movement…”

Section: Function-preserving Gastrectomy As Snnsmentioning

confidence: 99%

A new stage of sentinel node navigation surgery in early gastric cancer

et al. 2014

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Sentinel node (SN) navigation surgery is expected to realize organ-and function-preserving surgery with SN mapping, and has been applied in operations for breast cancer and melanoma. But there has been no definite evidence for the SN concept in gastric cancer. A prospective multicenter trial to confirm the SN concept for gastric cancer conducted by the Japan Society of Sentinel Node Navigation Surgery reported that the SN detection rate, sensitivity of positive SNs, and accuracy of nodal status are 97.5 % (387/397), 93 % (53/57), and 99 % (383/ 387), respectively. A detailed analysis of the trial suggested that strictly the ''lymphatic basin concept'' rather than the ''SN concept'' was confirmed in early gastric cancer. The Japan Society of Sentinel Node Navigation Surgery started a new trial of function-preserving gastrectomy with lymphatic basin dissection (LBD) for early gastric cancer without metastasis in SNs on the basis of this promising outcome of the trial. It is supposed that LBD guarantees curability in SN navigation surgery for early gastric cancer. Full-thickness resection or endoscopic submucosal dissection in combination with laparoscopic LBD will soon be a new treatment option for early gastric cancer.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2007

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Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer

Cited by 76 publications

References 8 publications

Lymph node dissection in the resection of gastric cancer: Review of existing evidence

Lymph node dissection in the resection of gastric cancer: Review of existing evidence

A new stage of sentinel node navigation surgery in early gastric cancer

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

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