Gastric Cancer

, Volume 21, Issue 5, pp 864–870 | Cite as

Clinical outcomes of intraoperative manual dilatation of pylorus in pylorus-preserving gastrectomy: a retrospective analysis

  • Chun-Chao Zhu
  • Tae-Han Kim
  • Felix Berlth
  • Shin-Hoo Park
  • Yun-Suhk Suh
  • Seong-Ho Kong
  • Hyuk-Joon Lee
  • Hui Cao
  • Han-Kwang Yang
Original Article



Delayed gastric emptying is one of the most disturbing complications of pylorus-preserving gastrectomy (PPG) and it increases hospital stay. We investigated the clinical outcome of intraoperative manual dilatation of the pylorus as a preventive method of pyloric spasm after PPG.

Materials and methods

We reviewed gastric cancer patients who underwent PPG between January 2014 and December 2016 at Seoul National University Hospital by a single surgeon. During operation, manual dilatation (MD) was performed after laparoscopic dissection and gastric resection by mini-laparotomy. Pyloric stenosis was diagnosed by the finding of severe narrowing in pylorus on upper gastrointestinal series (UGIS), if patients suffered from postprandial abdominal fullness and discomfort. Patient’s characteristics, surgical data and complication data were reviewed and compared between the groups (MD vs non-MD).


232 patients were included in this study. 93 patients underwent manual dilatation (40.1%). The overall complication rate was 12.9% in the MD group and 18.7% in the non-MD group (p = 0.242). Mean postoperative stay was 10.0 ± 5.8 in the MD group versus 10.9 ± 8.4 in the non-MD group (p = 0.304). Only one case suffered pylorus stenosis in the MD group (1.1%) but there were twelve cases seen in the non-MD group (8.6%), which reflects a significant difference (p = 0.019).


Simple intraoperative manual dilatation of pylorus may provide prevention from pyloric stenosis caused by pyloric spasms for patients who undergo PPG.


Manual dilatation Pylorus-preserving gastrectomy Pyloric stenosis 


Compliance with ethical standards

Ethics statement

This retrospective study was conducted ethically in accordance with the Ethical Principles for Medical Research Involving Human Subjects, as outlined in The Declaration of Helsinki after approval of the institutional review board of Seoul National University Hospital (No. 1706-176-864). Informed consent was waved by the institutional review board based on its decision that the risk of this study to the patient is minimal.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10120_2018_814_MOESM1_ESM.docx (90 kb)
Supplementary material 1 (DOCX 89 kb)


  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRefPubMedGoogle Scholar
  2. 2.
    Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol. 2014;32:627–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Suh YS, Han DS, Kong SH, Kwon S, Shin CI, Kim WH, et al. Laparoscopy-assisted pylorus-preserving gastrectomy is better than laparoscopy-assisted distal gastrectomy for middle-third early gastric cancer. Ann Surg. 2014;259:485–93.CrossRefPubMedGoogle Scholar
  4. 4.
    Oh SY, Lee HJ, Yang HK. Pylorus-preserving gastrectomy for gastric cancer. J Gastric Cancer. 2016;16:63–71.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Shibata C, Saijo F, Kakyo M, Kinouchi M, Tanaka N, Sasaki I, et al. Society for the study of postoperative morbidity after G: current status of pylorus-preserving gastrectomy for the treatment of gastric cancer: a questionnaire survey and review of literatures. World J Surg. 2012;36:858–63.CrossRefPubMedGoogle Scholar
  6. 6.
    Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, et al. Long-term outcome and survival with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc. 2011;25:1182–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Aizawa M, Honda M, Hiki N, Kinoshita T, Yabusaki H, Nunobe S, et al. Oncological outcomes of function-preserving gastrectomy for early gastric cancer: a multicenter propensity score matched cohort analysis comparing pylorus-preserving gastrectomy versus conventional distal gastrectomy. Gastric Cancer. 2017;20:709–17.CrossRefPubMedGoogle Scholar
  8. 8.
    Fujita J, Takahashi M, Urushihara T, Tanabe K, Kodera Y, Yumiba T, et al. Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study. Gastric Cancer. 2016;19:302–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Han DS, Suh YS, Ahn HS, Kong SH, Lee HJ, Kim WH, et al. Comparison of surgical outcomes of robot-assisted and laparoscopy-assisted pylorus-preserving gastrectomy for gastric cancer: a propensity score matching analysis. Ann Surg Oncol. 2015;22:2323–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Ikeguchi M, Kuroda H, Kihara K, Hatata T, Matsunaga T, Fukuda K, et al. Nutritional assessment of patients after pylorus-preserving gastrectomy for early gastric cancer. Indian J Surg. 2010;72:453–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007;10:167–72.CrossRefPubMedGoogle Scholar
  12. 12.
    Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, et al. Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg. 2011;253:928–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Ikeguchi M, Hatada T, Yamamoto M, Miyake T, Matsunaga T, Fukuda K, et al. Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach. Surg Today. 2010;40:228–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Tanaka N, Katai H, Saka M, Morita S, Fukagawa T. Laparoscopy-assisted pylorus-preserving gastrectomy: a matched case-control study. Surg Endosc. 2011;25:114–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg. 2008;95:1131–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Nunobe S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, et al. Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg. 2007;31:2335–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Imada T, Rino Y, Takahashi M, Hatori S, Tanaka J, Shiozawa M, et al. Gastric emptying after pylorus-preserving gastrectomy in comparison with conventional subtotal gastrectomy for early gastric carcinoma. Surg Today. 1998;28:135–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Nagano H, Ohyama S, Sakamoto Y, Ohta K, Yamaguchi T, Muto T, et al. The endoscopic evaluation of gastritis, gastric remnant residue, and the incidence of secondary cancer after pylorus-preserving and transverse gastrectomies. Gastric Cancer. 2004;7:54–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Bae JS, Kim SH, Shin CI, Joo I, Yoon JH, Lee HJ, et al. Efficacy of gastric balloon dilatation and/or retrievable stent insertion for pyloric spasms after pylorus-preserving gastrectomy: retrospective analysis. PLoS One. 2015;10:e0144470.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  21. 21.
    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61:838–45.PubMedGoogle Scholar
  24. 24.
    Matsuki A, Nashimoto A, Yabusaki H, Nakagawa S. Long-term clinical outcome and survival after pylorus-preserving gastrectomy. Hepatogastroenterology. 2012;59:2012–5.PubMedGoogle Scholar
  25. 25.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.CrossRefGoogle Scholar
  26. 26.
    Lee JH, Kim CG, Kim YW, Choi IJ, Lee JY, Cho SJ, et al. Botulinum toxin injection for the treatment of delayed gastric emptying following pylorus-preserving gastrectomy: an initial experience. J Gastric Cancer. 2017;17:173–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kiyokawa T, Hiki N, Nunobe S, Honda M, Ohashi M, Sano T. Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy. Langenbecks Arch Surg. 2017;402:49–56.CrossRefPubMedGoogle Scholar
  28. 28.
    Park DJ, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008;32:1029–36.CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Chun-Chao Zhu
    • 1
    • 2
  • Tae-Han Kim
    • 3
  • Felix Berlth
    • 4
  • Shin-Hoo Park
    • 1
  • Yun-Suhk Suh
    • 1
  • Seong-Ho Kong
    • 1
  • Hyuk-Joon Lee
    • 1
    • 5
  • Hui Cao
    • 2
  • Han-Kwang Yang
    • 1
    • 5
  1. 1.Department of SurgerySeoul National University HospitalSeoulSouth Korea
  2. 2.Department of Gastrointestinal SurgeryRenji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
  3. 3.Department of SurgeryGyeongsang National University HospitalJinjuSouth Korea
  4. 4.Department of General, Visceral and Cancer SurgeryUniversity Hospital CologneCologneGermany
  5. 5.Cancer Research InstituteSeoul National UniversitySeoulSouth Korea

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