Oncological outcomes of function-preserving gastrectomy for early gastric cancer: a multicenter propensity score matched cohort analysis comparing pylorus-preserving gastrectomy versus conventional distal gastrectomy

Abstract

Objective This study aimed to clarify the oncological safety of pylorus-preserving gastrectomy (PPG) compared with conventional distal gastrectomy (DG). Methods From three institutions specializing in cancer, the medical records for a cohort of 2898 consecutive patients who had undergone DG (n = 2208) or PPG (n = 690) for clinical stage I gastric cancer between January 2006 and December 2012 were analyzed. A propensity score for each patient was estimated on the basis of 38 preoperative clinical and tumor-related factors. After propensity score matching had been done, 1004 patients (502 DG patients, 502 PPG patients) were included in the analysis. The overall survival, relapse-free survival, and occurrence of secondary gastric cancer were then compared. The median observation period was 48.6 months (range 1-109.8 months). Results The 5-year overall survival rate was 98.4 % for the PPG group and 96.6 % for the DG group (hazard ratio 0.48, 95 % confidence interval 0.21-1.09, P = 0.07). The 3-year relapse-free survival rate was 99.5 % for the PPG group and 98.0 % for the DG group (hazard ratio 0.39, 95 % confidence interval 0.12-1.33, P = 0.12). Postoperative secondary gastric cancer was encountered in eight patients (1.6 %) in the PPG group and four patients (0.8 %) in the DG group. No significant differences in either overall survival, relapse-free survival, or the occurrence of secondary gastric cancer were observed between the two groups. Conclusions Given the adequate estimation of the clinical tumor stage, the oncological safety of PPG for clinical T1N0 gastric cancer in the middle portion of the stomach was comparable to that of DG.

Function-preserving surgery for gastric cancer: current status and future perspectives

“…Randomized controlled trials should resolve these clinical questions, and the Korean Laparoscopic Gastrointestinal Surgery Study (KLASS)-04, a multicenter randomized controlled trial which has been recruiting patients since July 2015, will determine the superiority of LAPPG to laparoscopic DG in postoperative QOL and survival rates of patients with EGC in the gastric midbody. Additionally, we recently reported the comparison of oncological outcomes with PPG and conventional DG for EGC in a multicenter propensity score-matched cohort analysis (20). Our findings indicated that the oncological safety of PPG for clinical T1N0 gastric cancer in the middle portion of the stomach was comparable to that of DG in cases with correctly estimated clinical tumor stage by the statistical method.…”

“…Several retrospective reports with relatively a great many patients who underwent PPG consistently showed the oncological safety of PPG (17)(18)(19)(20)(21). PPG procedures that were evaluated those that preserved the nerve system and blood flow supply to the pyloric antrum for maintenance of the pyloric function, which resulted in incomplete lymph node dissection of the suprapyloric and infrapyloric lymph nodes.…”

Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?

“…Nonetheless, PPG, as a typical function-preserving gastrectomy, has been demonstrated to show further advantages in functional outcomes compared to distal gastrectomy in middle third EGC [7,28,29]. In addition, the oncological safety of PPG operation has been demonstrated in large retrospective studies [7,9,30]. To gain more evidence about the functional outcome, KLASS-04, a multicenter randomized-controlled trial comparing laparoscopic pylorus-preserving gastrectomy (LPPG) versus laparoscopic distal gastrectomy (LDG) for the middle third early gastric cancer has finished recruitment in Korea [11].…”

“…1 3 rate. For early gastric cancer, surgeons started to consider functional preserving gastrectomy to improve the functional outcome and quality of life (QOL) without compromising oncological safety [5][6][7][8][9][10]. Pylorus-preserving gastrectomy (PPG) is such kind of function-preserving surgery, which has gained popularity in East Asian countries [5,[11][12][13].…”

GTPBP4 Promotes Gastric Cancer Progression via Regulating P53 Activity

“…Gastric cancer is a kind of tumor with high morbidity and mortality [1]. Although surgical treatment, chemotherapy and radiotherapy could greatly improve the survival of patients with gastric cancer, which could not be cured or recurred within several years [2].…”