Preventive effect on delayed gastric emptying of preserving the infra-pyloric vein in laparoscopic pylorus-preserving gastrectomy for early gastric cancer

Kaji, Shuichiro; Makuuchi, Rie; Irino, Tomoyuki; Tanizawa, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Omori, Hayato; Fujiya, Keiichi; Nishiwaki, Noriyuki; Furukawa, Katsunori; Nakamura, Kenichi; Koseki, Yusuke; Waki, Yuhei; Asaoka, Raito; Terashima, Masanori

doi:10.1007/s00464-019-07151-9

Cited by 10 publications

(7 citation statements)

References 31 publications

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“…Our previous study showed that preservation of the infrapyloric vein may prevent the incidence of postoperative gastric stasis after LPPG [16]. Although the present study was larger, the data did not show that preservation of the infrapyloric vein prevented E-stasis, similar to smaller studies by Nishizawa et al and Kaji et al [20,33]. Unfortunately, the previous study might be misleading due to the small sample size.…”

Section: Discussioncontrasting

confidence: 47%

Risk factors and prognosis of gastric stasis, a crucial problem after laparoscopic pylorus-preserving gastrectomy for early middle-third gastric cancer

et al. 2020

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Background Pylorus-preserving gastrectomy (PPG) is a function-preserving procedure for cT1N0 gastric cancer located in the middle-third of stomach, which is currently performed through a laparoscopic approach (LPPG). PPG is sometimes associated with a crucial problem during the early postoperative course, designated gastric stasis. However, information regarding gastric stasis remains to be fully elucidated. Methods The study included 897 patients who underwent LPPG between 2005 and 2017. Early postoperative gastric stasis (E-stasis) was defined when the following conditions were fulfilled: upper abdominal distension, remnant stomach fullness on radiography image, and period of starvation exceeding 72 h within 1 month postoperatively. To evaluate long-term outcomes of E-stasis, late postoperative food residue (L-residue) was defined as grade 2 or higher food residue endoscopically according to the RGB (residue, gastritis, bile) classification at 1 year postoperatively. Risk factors and long-term outcomes of E-stasis were retrospectively analyzed. Results E-stasis was the most common complication during the early postoperative course. E-stasis occurred in 68 (7.6%) patients. Multivariate analysis identified age (≥ 61 years), DM, and postoperative intraabdominal infection as risk factors. At 1 year postoperatively, relative body weight ratio and postoperative serum albumin in the patients who experienced E-stasis was significantly lower than those in the other patients (P = 0.042 and 0.011, respectively). Of the patients who suffered from E-stasis, 42.5% experienced L-residue. Conclusions E-stasis after LPPG occurs in 7.6% of patients. Age, DM, and intraabdominal infection are significantly related to E-stasis. E-stasis is associated with poorer nutritional and functional outcomes even at 1 year postoperatively.

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Section: Discussioncontrasting

confidence: 47%

Risk factors and prognosis of gastric stasis, a crucial problem after laparoscopic pylorus-preserving gastrectomy for early middle-third gastric cancer

et al. 2020

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“…Studies have shown that compared to distal gastrectomy (DG), PPG has lower incidence of dumping syndrome, bile reflux, gallstone formation, and improved nutritional status with comparable oncologic outcomes [3][4][5][6][7][8][9][10][11][12]. However, one of the most concerning complications is delayed gastric emptying (DGE) [4,[13][14][15][16][17][18][19][20]. Radiologic intervention is generally used in such cases and the method used in our center includes balloon dilatation and retrievable stent insertion [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Radiologic intervention due to delayed gastric emptying after pylorus preserving gastrectomy for gastric cancer does not affect pyloric function

Lim

Park

Cho

et al. 2020

Korean J Clin Oncol

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The purpose of this study is to evaluate whether radiologic intervention in the pylorus decreases its function for delayed gastric emptying (DGE) patients after pylorus preserving gastrectomy (PPG) for gastric cancers and to determine the optimal interventional algorithm. Methods: PPG patients who underwent intervention for DGE from January 2013 to December 2017 and a control group using propensity score matching were identified. Pyloric function was compared by subjective symptoms, postoperative upper gastrointestinal series at 3 months (short-term function), and esophagogastroduodenoscopy findings at 12 months (long-term function). Serum albumin levels and body weight change, 6 months and 12 months postoperatively, were compared to evaluate nutritional status. Interventional success rate, mean hospital stay, and recurrence of DGE were analyzed to determine the optimal intervention plan. Results: Fifty-one out of 677 patients (7.53%) received intervention. There was no difference in pyloric function and nutritional status between the intervention and control groups. The interventional success rate for first-time balloon dilatation was 41.7% (20/48). If a second intervention was required and balloon dilatation was done, the success rate was 45.5% (5/11). However, if stent insertion was done, the success rate was 100% (17/17). Subsequent stent insertion after balloon dilatation resulted in a shorter mean hospital stay. Intervention including stent insertion had a lower recurrence of DGE than balloon only intervention (1.96% vs. 5.88%, P=0.041). Conclusion: Radiologic intervention did not decrease long-term pyloric function. For treating DGE, if at first balloon dilatation fails, retrievable stent insertion can be considered as a second choice.

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“…Kiyokawa et al demonstrated that venous stasis due to IPV division could cause pyloric edema, which might cause pyloric dysfunction and DGE [19]. However, Kaji et al reported that preserving IPV did not help prevent DGE in laparoscopic and robotic PPG [15]. The influence of preserving IPV for DGE after PPG remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…DGE including gastric stasis is one of the most common problems after PPG [ 1 , 6 , 7 ]. Its incidence has been reported to be 6.3–10% in recent years [ 1 , 6 – 8 , 15 , 19 ]. In our study, the incidence of DGE was 9.1% in the TLPPG group, but it did not decrease in the LAPPG group (7%).…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative complications were defined according to the Clavien–Dindo classification [ 14 ]. Delayed gastric emptying (DGE), including gastric stasis, was also defined according to the Clavien–Dindo classification and diagnosed according to Kaji et al’s definition, i.e., upper abdominal distension, nausea, or vomiting, accompanied with the retention of the remnant stomach on abdominal X-ray [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

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Feasibility of totally laparoscopic pylorus-preserving gastrectomy with intracorporeal gastro-gastrostomy for early gastric cancer: a retrospective cohort study

et al. 2020

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Background: Pylorus-preserving gastrectomy (PPG) has been accepted as a function-preserving surgery for the treatment of early gastric cancer in East Asian countries. Therefore, this study aimed to evaluate the feasibility and safety of totally laparoscopic PPG (TLPPG) with intracorporeal anastomosis. Methods: A total of 43 patients with early gastric cancer underwent laparoscopy-assisted PPG (LAPPG) with extracorporeal anastomosis between May 2006 and November 2012. The operative outcomes of 22 patients who underwent TLPPG between November 2012 and February 2019 were evaluated, and data were compared with that of the LAPPG group. Results: No significant difference in the operative time was observed between the two groups. Blood loss was lower in the TLPPG group (18.5 mL) than in the LAPPG group (30.7 mL, p = 0.008), and the length of abdominal incision was shorter in the TLPPG group (3.8 cm) than in the LAPPG group (4.7 cm, p < 0.001). No significant difference in the complication rate was observed between the two groups (13.6% in the TLPPG vs. 9.3% in the LAPPG group, p = 0.594). No anastomosis-related complications occurred in either group. No significant betweengroup difference was observed in the delayed gastric emptying (TLPPG, 9.1 vs. LAPPG, 7%, p = 0.762). The initiation of postoperative fluid (TLPPG, 1.0 day vs. LAPPG, 3.0 days, p < 0.001) and meal (TLPPG, 3.0 days vs. LAPPG, 4.0 days, p < 0.001) intake was earlier in the TLPPG group than in the LAPPG group. No significant between-group difference was observed in the postoperative hospital stay. Conclusions: The findings of this study suggest that TLPPG with intracorporeal reconstruction not only is as feasible and safe as LAPPG for the treatment of patients with early gastric cancer but also provides certain advantages such as reduced blood loss and wound size.

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Preventive effect on delayed gastric emptying of preserving the infra-pyloric vein in laparoscopic pylorus-preserving gastrectomy for early gastric cancer

Cited by 10 publications

References 31 publications

Risk factors and prognosis of gastric stasis, a crucial problem after laparoscopic pylorus-preserving gastrectomy for early middle-third gastric cancer

Risk factors and prognosis of gastric stasis, a crucial problem after laparoscopic pylorus-preserving gastrectomy for early middle-third gastric cancer

Radiologic intervention due to delayed gastric emptying after pylorus preserving gastrectomy for gastric cancer does not affect pyloric function

Feasibility of totally laparoscopic pylorus-preserving gastrectomy with intracorporeal gastro-gastrostomy for early gastric cancer: a retrospective cohort study

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