Laparoscopy-Assisted Pylorus-Preserving Gastrectomy with Quality Controlled Lymph Node Dissection in Gastric Cancer Operation

Hiki, Naoki; Shimoyama, Shouji; Yamaguchi, Hideyo; Kubota, Keiichi; Kaminishi, Michio

doi:10.1016/j.jamcollsurg.2006.05.003

Cited by 59 publications

(54 citation statements)

References 27 publications

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“…Laparoscopic or laparoscopy-assisted gastrectomy (LAG) is now well accepted and widely used as a minimally invasive surgical treatment for EGC. Many studies have demonstrated the safety and advantage of LAG over conventional open gastrectomy [2][3][4]. Laparoscopy-assisted distal gastrectomy (LADG) is the most commonly used laparoscopic surgery because most EGCs are located in the middle or lower third of the stomach.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

et al. 2011

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Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopyassisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant stomach by using the OrVil TM system. The reconstruction method was Rouxen-Y, and hemidouble-stapling gastrojejunostomy with a circular stapler was performed intracorporeally. There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 266.7 min and 54.6 ml, respectively. The overall incidence of early postoperative complications was 17.4%, and two patients underwent reoperation because of duodenal stump leakage and stenosis of the Y-anastomosis, respectively. During the follow-up period, two patients experienced gastrojejunostomy stenosis and both were treated successfully by endoscopic balloon dilation. LAsTG may be performed in selected patients with EGC in the upper stomach. With the described method, a very small remnant stomach can be preserved.

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Section: Introductionmentioning

confidence: 99%

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

et al. 2011

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“…PPG was originally used for the treatment of peptic ulcer, and it has been introduced as a surgical therapy for EGC that is designed to preserve function and maintain a better quality of life [49][50][51][52][53] . By preserving pyloric function, it has several nutritional advantages and has less postgastrectomy-related disorders, such as dumping syndrome and alkaline reflux, a lower incidence of disturbed bowel habits, and a reduced flatus frequency [26,54,55] .…”

Section: Laparoscopic Function-preserving Surgerymentioning

confidence: 99%

Minimally Invasive Surgery of Gastric Cancer

Güner

Hyung

2017

Minimally Invasive Surgery for Upper Abdominal Cancer

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Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short-and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Gastric cancer; Minimally invasive surgery; Laparoscopic gastrectomyCore tip: Minimally invasive surgery has become an alternative modality for the treatment of gastric cancer.Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20(39): 14132-14141 Available from: URL: http://www.wjgnet.com/1007-9327/full/ v20/i39/14132.htm DOI: http://dx.doi.org/10.3748/wjg.v20. tano et al [9] and Nagai et al [10] reported the success of laparoscopy-assisted distal gastrectomy (LADG) for EGC in 1994 and 1995. In the early 2000s, robot-assisted surgery emerged as one of the treatment modalities for EGC, and the first robot-assisted gastrectomy (RAG) for EGC was reported by Hashizume et al [11] in 2003. In 2011, singleincision laparoscopic surgery was described for EGC [12] . MIS has revolutionized the surgical approach to gastric cancer for the past two decades, leading to improvements in patients' quality of life by producing less pain, less blood loss, earlier postoperative recovery, and a shorter hospital stay [13][14][15][16][17][18][19] .Currently, MIS is evolving in two major directions [20] . First, MIS techniques are being used in more radical but less invasive procedures, such as totally laparoscopic distal gastrectomy or laparoscopic total gastrectomy with D1+ or D2 lymphadenectomy. These procedures are comparable to conventional open surgery and can be performed even in patients with advanced gastric cancer (AGC) [21][22][23] . Second, MIS is being employed for function-preserving surgery, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, and limited gastrectomy with sentinel node navigation surgery. These procedures can assist in improving patients' late postoperative function and quality of life [20,[24][25][26] . RECENT ADVANCES IN LAPAROSCOPIC GASTRECTOMYAs advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complicat...

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“…This finding suggests that the delicate manipulations of hand-sewn anastomosis might avoid deformity of the proximal gastric remnant, and that insufficient flexibility in the anastomotic site caused by the use of staples might contribute to nausea. Although PPG preserves gastric function, patients occasionally have a feeling of gastric fullness after food intake, and some experience long-term retention of food in the residual stomach [16][17][18]. Delayed gastric emptying is the most common complaint after PPG, and it manifests as various symptoms including nausea, epigastric fullness, and poor oral intake [7,17,19].…”

Section: C01mentioning

confidence: 99%

“…Although PPG preserves gastric function, patients occasionally have a feeling of gastric fullness after food intake, and some experience long-term retention of food in the residual stomach [16][17][18]. Delayed gastric emptying is the most common complaint after PPG, and it manifests as various symptoms including nausea, epigastric fullness, and poor oral intake [7,17,19]. Lee et al [20] performed intracorporeal gastro-gastric anastomosis with mechanical suture devices in laparoscopic PPG (LAPPG) operations on 12 patients, and advocated that this technique has the potential to provide a better QOL following gastric cancer surgery because of the low incidence of morbidity and no stasis; however, the sample size was small.…”

Section: C01mentioning

confidence: 99%

“…In contrast, Morita et al [24] reported that there were no significant differences in symptoms, such as dumping syndrome or emptying disturbances, between patients with pyloric cuff lengths 3.0 cm or less and those with lengths more than 3.0 cm. Shibata et al [17] concluded that it is uncertain what length of pyloric cuff is reasonable for PPG in terms of gastric emptying. Our results showed that there were significant differences in terms of the score for diarrhea subscale, diarrhea, and sense of foods sticking between patients grouped according to the length of pyloric cuff (\2.5, 3.0-5.0, or [5.5 cm) analyzed by ANOVA.…”

Section: C01mentioning

confidence: 99%

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Factors that minimize postgastrectomy symptoms following pylorus-preserving gastrectomy: assessment using a newly developed scale (PGSAS-45)

et al. 2014

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Background Pylorus-preserving gastrectomy (PPG) is sometimes performed as a function-preserving surgery for the treatment of early gastric cancer. The aim of this study was to use an integrated assessment scale for postgastrectomy syndrome to determine the appropriate indicators and optimal methods for PPG. Methods The Postgastrectomy Syndrome Assessment Study (PGSAS) is a multicenter survey based on an integrated questionnaire (PGSAS-45) consisting of 45 items. Questionnaire responses were retrieved from a total of 2,520 patients, each of whom had undergone one of six different types of gastrectomy procedures; 313 responses from patients who had received PPG were analyzed here. Results The size of the proximal gastric remnant (less than one-quarter, about one-third, or more than one-half of the original size) significantly influenced the change in body weight, the scores for dissatisfaction at the meal, and dissatisfaction for daily life subscale (P = 0.030, P = 0.005, P = 0.034, respectively). The nausea score in patients who underwent hand-sewn anastomosis was significantly lower than in those who underwent anastomosis with a linear stapler (P = 0.006). The scores for diarrhea subscale, increased passage of stools, and sense of foods 123Gastric Cancer (2015) 18:397-406 DOI 10.1007/s10120-014-0366-y sticking differed significantly depending on the length of the preserved pyloric cuff (P = 0.047, P = 0.021, P = 0.046, respectively). Conclusions The results suggest that preservation of a sufficient proximal gastric remnant is recommended when utilizing PPG as function-preserving surgery.

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Laparoscopy-Assisted Pylorus-Preserving Gastrectomy with Quality Controlled Lymph Node Dissection in Gastric Cancer Operation

Cited by 59 publications

References 27 publications

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Minimally Invasive Surgery of Gastric Cancer

Factors that minimize postgastrectomy symptoms following pylorus-preserving gastrectomy: assessment using a newly developed scale (PGSAS-45)

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