Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

Nunobe, Souya; Sasako, Mitsuru; Saka, Makoto; Fukagawa, Takeo; Katai, H.; Sano, Takeshi

doi:10.1007/s10120-007-0434-7

Cited by 120 publications

(101 citation statements)

References 23 publications

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“…Our recent study also showed the safety and radicality of PPG as a standard operation for EGC located in the middle body [12]. We have also reported that, as shown by the longterm follow-up results, PPG has clear advantages over distal gastrectomy with Billroth-I reconstruction, in terms of postoperative symptoms and functional outcomes [13].Initially, the length of the preserved pyloric cuff was 1.5 cm, as Maki et al noted in the original article describing PPG [10]. Subsequently, Nakane et al [14] reported that PPG with the transection of 2.5 cm proximal to the pyloric ring was superior to that with the transection of 1.5 cm in terms of some postoperative symptoms and weight recovery.…”

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confidence: 58%

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confidence: 61%

“…Among the limited options for the surgical treatment of EGC, PPG is the only one to have been proven to provide satisfactory digestive function [12,13] according to the Japanese Gastric Cancer Association Guidelines for treatment of gastric cancer [18]. While PPG has several additional benefi ts, such as the prevention of dumping syndrome, regaining of weight, maintenance of pancreatic secretory function, prevention of duodenal juice refl ux, and a low incidence of gallstones [19][20][21][22], it leads to the development of the characteristic postoperative symptom of delayed gastric emptying, at a constant rate [20,21].…”

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confidence: 99%

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Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy

et al. 2010

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ment from EGC is low, and involved lymph nodes are fundamentally confi ned to the perigastric area [7][8][9]. Therefore, Japanese surgeons have re-evaluated the treatment strategy of exclusive radical D2 gastrectomy for EGC and focused on function-preserving gastrectomy to attenuate postoperative symptoms such as weight loss, dumping syndrome, and residual gastritis caused by bile refl ux, these being well known as frequent problems after subtotal gastrectomy.Pylorus-preserving gastrectomy (PPG) is a modifi ed distal gastrectomy for the treatment of gastric ulcers, designed by Maki et al. [10] in 1967 as a functionpreserving procedure. PPG is aimed at maintaining stomach capacity and reducing the amount of regurgitated duodenal juice by preserving the pyloric antrum. A limited lymph node dissection, as performed in the PPG operation, was shown to be a suffi ciently safe and effective treatment for EGC by Kodama and Koyama in 1991 [11]. Since 1995, we have actively utilized PPG for the treatment of EGC in the middle body to minimize postoperative dysfunction in patients. Our recent study also showed the safety and radicality of PPG as a standard operation for EGC located in the middle body [12]. We have also reported that, as shown by the longterm follow-up results, PPG has clear advantages over distal gastrectomy with Billroth-I reconstruction, in terms of postoperative symptoms and functional outcomes [13].Initially, the length of the preserved pyloric cuff was 1.5 cm, as Maki et al. noted in the original article describing PPG [10]. Subsequently, Nakane et al. [14] reported that PPG with the transection of 2.5 cm proximal to the pyloric ring was superior to that with the transection of 1.5 cm in terms of some postoperative symptoms and weight recovery. Recently, Nunobe et al. [15] showed the low frequency of gastric stasis in patients with a 3-cm length of pyloric cuff. Thus, in clinical practice, the length of the preserved pyloric cuff has tended to be increased, compared to that in the initial setting. By Abstract Background. Recent years have seen the preserved pyloric cuff being lengthened in pylorus-preserving gastrectomy for early gastric cancer. We performed clinical assessment of the symptoms after pylorus-preserving gastrectomy in patients treated at the National Cancer Center Hospital in Japan during the past 9 years. Methods. Four hundred and fi fty-six patients who had undergone pylorus-preserving gastrectomy and been followed up for at least 3 years were studied. We classifi ed the patients into two groups according to the length of the pyloric cuff (group A, within 3.0 cm; group B, more than 3.0 cm). Medical records were reviewed for further histological and follow-up data. A questionnaire regarding dumping syndrome and gastric stasis was also completed by the patients. Results. Our results showed no statistically signifi cant differences in symptoms, such as dumping syndrome or emptying disturbances, between the two groups. Conclusion. Our study revealed that the differences in several functio...

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Section: Discussionmentioning

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Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy

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“…There are many studies reporting postoperative objective and subjective outcomes of pylorus-preserving gastrectomy, a subtype of transectional gastrectomy. To summarize, weight loss is less [40], dumping syndrome or early emptying occurs less frequently [41], regurgitant gastritis is milder [42,43], disturbed bowel movement…”

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A new stage of sentinel node navigation surgery in early gastric cancer

et al. 2014

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Sentinel node (SN) navigation surgery is expected to realize organ-and function-preserving surgery with SN mapping, and has been applied in operations for breast cancer and melanoma. But there has been no definite evidence for the SN concept in gastric cancer. A prospective multicenter trial to confirm the SN concept for gastric cancer conducted by the Japan Society of Sentinel Node Navigation Surgery reported that the SN detection rate, sensitivity of positive SNs, and accuracy of nodal status are 97.5 % (387/397), 93 % (53/57), and 99 % (383/ 387), respectively. A detailed analysis of the trial suggested that strictly the ''lymphatic basin concept'' rather than the ''SN concept'' was confirmed in early gastric cancer. The Japan Society of Sentinel Node Navigation Surgery started a new trial of function-preserving gastrectomy with lymphatic basin dissection (LBD) for early gastric cancer without metastasis in SNs on the basis of this promising outcome of the trial. It is supposed that LBD guarantees curability in SN navigation surgery for early gastric cancer. Full-thickness resection or endoscopic submucosal dissection in combination with laparoscopic LBD will soon be a new treatment option for early gastric cancer.

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“…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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Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

Cited by 120 publications

References 23 publications

Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy

Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy

A new stage of sentinel node navigation surgery in early gastric cancer

Minimally Invasive Surgery of Gastric Cancer

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