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Gastric Cancer

, Volume 22, Issue 4, pp 881–891 | Cite as

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

  • Chun-Chao Zhu
  • Hui Cao
  • Felix Berlth
  • Jia Xu
  • Shin-Hoo Park
  • Hwi-Nyeong Choe
  • Yun-Suhk Suh
  • Seong-Ho Kong
  • Hyuk-Joon Lee
  • Woo-Ho Kim
  • Han-Kwang YangEmail author
Original Article
  • 152 Downloads

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.

Keywords

Pylorus-preserving gastrectomy Upper stomach Early gastric cancer Outcomes 

Notes

Acknowledgements

This study is supported by fund of Seoul National University Hospital College of Medicine Research Foundation (0420163130), and Projects of Science and Technology Commission of Shanghai Municipality (15410723000). Felix Berlth is supported by the German Research Foundation.

Compliance with ethical standards

Conflict of interest

No conflict of interest exists.

Ethics statement

This study was conducted in accordance with the Ethical Principles for Medical Research Involving Human Subjects, as outlined in the Declaration of Helsinki after the approval of the institutional review board of Seoul National University Hospital. Informed consent was waived by the institutional review board based on its decision that the risk of this study to the patient is minimal. The research protocol was approved by the institutional review board of Seoul National University Hospital (No. 1707-157-874).

Supplementary material

10120_2018_921_MOESM1_ESM.docx (2.7 mb)
Supplementary material 1 (DOCX 2780 KB)

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  1. 1.Department of SurgerySeoul National University HospitalSeoulSouth Korea
  2. 2.Department of Gastrointestinal Surgery, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  3. 3.Department of General, Visceral and Cancer SurgeryUniversity Hospital CologneCologneGermany
  4. 4.Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
  5. 5.Department of PathologySeoul National University HospitalSeoulSouth Korea

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