Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?
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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.
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.
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).
For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.
KeywordsPylorus-preserving gastrectomy Upper stomach Early gastric cancer Outcomes
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.
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).
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