Short-term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer: Comparison Between Extracorporeal and Intracorporeal Gastrogastrostomy

Abstract

Purpose This study aimed to compare the surgical and oncological outcomes between totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with intracorporeal anastomosis and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with extracorporeal anastomosis. Materials and Methods A retrospective analysis was performed in 258 patients with cT1N0 gastric cancer who underwent laparoscopic pylorus-preserving gastrectomy using two different anastomosis methods: TLPPG with intracorporeal anastomosis (n=88) and LAPPG with extracorporeal anastomosis (n=170). The following variables were compared between the two groups to assess the postoperative surgical and oncological outcomes: proximal and distal margins, number of resected lymph nodes (LNs) in total and in LN station 6, operation time, postoperative hospital stay, and postoperative morbidity including delayed gastric emptying (DGE). Results The average length of the proximal margin was similar between the TLPPG and LAPPG groups (2.35 vs. 2.73 cm, P=0.070). Although the distal margin was significantly shorter in the TLPPG group than in the LAPPG group (3.15 vs. 4.08 cm, P=0.001), no proximal or distal resection margin-positive cases were reported in either group. The average number of resected LN was similar in both groups (36.0 vs. 33.98, P=0.229; LN station 6, 5.72 vs. 5.33, P=0.399). The operation time was shorter in the TLPPG group than in the LAPPG (200.17 vs. 220.80 minutes, P=0.001). No significant differences were observed between the two groups in terms of postoperative hospital stay (9.38 vs. 10.10 days, P=0.426) and surgical complication rate (19.3% vs. 22.9%), including DGE (8.0% vs. 11.8%, P=0.343). Conclusions The oncological safety and postoperative complications of TLPPG with intracorporeal anastomosis are similar to those of LAPPG with extracorporeal anastomosis.

Totally Laparoscopic Pylorus-Preserving Gastrectomy (TLPPG) is Safe and Effective for Early Gastric Cancer Treatment

“…The smaller incision led to less tissue damage compared to conventional laparotomy and laparoscopic-assisted surgery 12) , this will reduce the obstruction caused by adhesion of the stomach or intestines and reduce abdominal pains. As compared to LAPPG, the small incisions required for TLPPG remained uniform in size between patients and were independent of patient factors, leading to a potential advantage for using the technique [13][14][15] . The score of the dyspepsia subscale was also lower than that of the PGSAS group.…”

Pylorus-preserving gastrectomy for early gastric cancer

“…Additionally, the antrum and proximal remnant stomach twist partially around the anastomosis, and the lesser curvature side was not used for anastomosis[ 15 ]. A retrospective analysis showed no significant difference in proximal margin, the number of lymph nodes, surgical complication and postoperative hospital stay between intracorporeal and extracorporeal anastomosis[ 17 ]. Ohashi et al [ 18 ] reported the “piercing method” to perform intracorporeal end-to-end anastomosis with a linear stapler, but this method is cumbersome and time-consuming.…”

Comparison between laparoscopic pylorus-preserving gastrectomy and laparoscopic distal gastrectomy for overweight patients with early gastric cancer

“…Operations were performed by 4 experienced surgeons. Surgical procedures for LPPG and LDG were the same as previously reported [ 5 8 ]. The infrapyloric artery and vein, the hepatic branch of the vagus nerve, and the first branch of the right gastric artery were preserved without complete lymph node dissection of station 5.…”