Objective evaluation of clinical outcomes of laparoscopy-assisted pylorus-preserving gastrectomy for middle-third early gastric cancer

Abstract

Background Laparoscopic-assisted pylorus-preserving gastrectomy (LAPPG) is a minimally invasive function-preserving surgery for early gastric cancer. This study was designed to investigate the clinical outcomes between LAPPG and laparoscopy-assisted distal gastrectomy (LADG) by objective evaluation. Methods A total 167 pT1N0M0 gastric cancer patients underwent LAPPG( n = 70) and LADG( n = 97) were retrospectively analyzed. By evaluating the functional advantages, objective short-term and one year follow-up outcomes were compared. Results There is no significant difference in perioperative clinical characteristics as well as pathologic results between LAPPG and LADG group while the cost is higher in latter( p = 0.004). The Clavien–Dindo grade II or higher complications were 15.7 and 13.4% in LAPPG and LADG group respectively( p = 0.824). In one year follow-up, nutritional status was significantly better in LAPPG group accompanied by better pylorus function preserving. Conclusion LAPPG is an acceptable surgical procedure for pT1N0M0 middle portion gastric cancer patients in terms of nutritional and economic advantage. Trial registration Chinese Clinical Trial Registry ( ChiCTR-PIC-17012358 , Date of Registration:2017-08-14).

A comparison between pylorus-preserving and distal gastrectomy in surgical safety and functional benefit with gastric cancer: a systematic review and meta-analysis

“…Moreover, comparing with patients with an antral cuff of 1.5 cm, better postoperative outcomes were found in those who had a 2.5 cm antral cuff [40]. In addition, the incidence of gastric stasis was lower with preservation of infra-pyloric blood supply in conventional pylorus-preserving gastrectomy (cPPG), which ranged from 5.7 to 8.0% reported previously [7,9,41,42]. Kiyokawa et al showed that delayed gastric emptying was found in 8.5% patients from the cPPG group but no patient in group with the preservation of infra-pyloric vein [42].…”

“…The first meta-analysis, which was published in 2014 [10], demonstrated that PPG had superior benefits in terms of lower incidence rates of early dumping syndrome, gastritis, and bile reflux as well as regaining of weight. According to the Japanese Gastric Cancer Treatment Guidelines and considerable newly published studies with relatively comprehensive data [5,7,11,12], indications as well as standardized management and treatment for PPG have been well established. Therefore, we performed an updated meta-analysis to demonstrate the surgery efficacy, oncologic safety, and function recovery of PPG.…”

A comparison between pylorus-preserving and distal gastrectomy in surgical safety and functional benefit with gastric cancer: a systematic review and meta-analysis

“…Owing to just one articles with < 3cm antral cuff was published, the results may be influenced by the relatively small sample size. Additionally, the incidence of gastric stasis was lower with preservation of infra-pyloric blood supply in conventional pylorus-preserving gastrectomy (cPPG), which ranged from 5.7% to 8.0% reported previously[7,9,39,40]. Kiyokawa et al showed that no DGE patient was found with the preservation of infra-pyloric vein, while 8.5% patients from the cPPG group[40].…”

“…Moreover, the retainment of pyloric cuff and vagal nerve in PPG provided advantages such as ameliorating postoperative gastritis, bile reflux, early dumping syndromes and improving nutritional status [4,5]. In PPG, the infrapyloric LNs are routinely dissected with preserving the infra-pyloric vessels, and the supra-pyloric LNs are usually omitted to preserve the right gastric artery and the hepatic branch of the vagal nerve [6,7].…”

“…Although many studies comparing PPG and DG in terms of surgical and functional outcomes have been published [7][8][9], whether PPG is better than DG for EGC without compromising oncological safety remains debatable because of lacking long-term oncologic outcomes and high-level evidence of RCTs. The first meta-analysis, which was published in 2014 [10], demonstrated that PPG had superior benefits in terms of lower incidence rates of early dumping syndrome, gastritis, and bile reflux as well as regaining of weight.…”