Chun-Chao Zhu1,2, Hui Cao2, Felix Berlth1,3, Jia Xu2, Shin-Hoo Park1, Hwi-Nyeong Choe1, Yun-Suhk Suh1, Seong-Ho Kong1, Hyuk-Joon Lee1,4, Woo-Ho Kim5, Han-Kwang Yang6,7. 1. Department of Surgery, Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03080, South Korea. 2. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 3. Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany. 4. Cancer Research Institute, Seoul National University, Seoul, South Korea. 5. Department of Pathology, Seoul National University Hospital, Seoul, South Korea. 6. Department of Surgery, Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03080, South Korea. hkyang@snu.ac.kr. 7. Cancer Research Institute, Seoul National University, Seoul, South Korea. hkyang@snu.ac.kr.
Abstract
BACKGROUND: Pylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach. METHODS: We included all patients of the period 2013-2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postoperative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development. RESULTS: Overall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p < 0.001), less blood loss (p = 0.002) and lower postoperative morbidity compared to TG. For lymph-node (LN) stations being resected in all groups, no difference was found in number of resected LN. Recurrence-free survival was similar for all groups. PPG showed advantages regarding postoperative body weight, hemoglobin, total protein, albumin in postoperative 6 and 12 month follow-up. Lowest decrease of abdominal fat area after 12 months was seen for PPG. Gallstone incidence was significantly lower after PPG compared to TG (p < 0.001). CONCLUSIONS: For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.
BACKGROUND: Pylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach. METHODS: We included all patients of the period 2013-2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postoperative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development. RESULTS: Overall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p < 0.001), less blood loss (p = 0.002) and lower postoperative morbidity compared to TG. For lymph-node (LN) stations being resected in all groups, no difference was found in number of resected LN. Recurrence-free survival was similar for all groups. PPG showed advantages regarding postoperative body weight, hemoglobin, total protein, albumin in postoperative 6 and 12 month follow-up. Lowest decrease of abdominal fat area after 12 months was seen for PPG. Gallstone incidence was significantly lower after PPG compared to TG (p < 0.001). CONCLUSIONS: For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.
Entities:
Keywords:
Early gastric cancer; Outcomes; Pylorus-preserving gastrectomy; Upper stomach
Authors: Fernando Marum Mauad; Francisco Abaeté Chagas-Neto; Augusto César Garcia Saab Benedeti; Marcello Henrique Nogueira-Barbosa; Valdair Francisco Muglia; Antonio Adilton Oliveira Carneiro; Enrico Mattana Muller; Jorge Elias Junior Journal: Radiol Bras Date: 2017 May-Jun
Authors: Sin Hye Park; Hong Man Yoon; Keun Won Ryu; Young-Woo Kim; Myeong-Cherl Kook; Bang Wool Eom Journal: World J Surg Oncol Date: 2022-09-26 Impact factor: 3.253