Risk factors and prognosis of gastric stasis, a crucial problem after laparoscopic pylorus-preserving gastrectomy for early middle-third gastric cancer

Abstract

Background

Pylorus-preserving gastrectomy (PPG) is a function-preserving procedure for cT1N0 gastric cancer located in the middle-third of stomach, which is currently performed through a laparoscopic approach (LPPG). PPG is sometimes associated with a crucial problem during the early postoperative course, designated gastric stasis. However, information regarding gastric stasis remains to be fully elucidated.

Methods

The study included 897 patients who underwent LPPG between 2005 and 2017. Early postoperative gastric stasis (E-stasis) was defined when the following conditions were fulfilled: upper abdominal distension, remnant stomach fullness on radiography image, and period of starvation exceeding 72 h within 1 month postoperatively. To evaluate long-term outcomes of E-stasis, late postoperative food residue (L-residue) was defined as grade 2 or higher food residue endoscopically according to the RGB (residue, gastritis, bile) classification at 1 year postoperatively. Risk factors and long-term outcomes of E-stasis were retrospectively analyzed.

Results

E-stasis was the most common complication during the early postoperative course. E-stasis occurred in 68 (7.6%) patients. Multivariate analysis identified age (≥ 61 years), DM, and postoperative intraabdominal infection as risk factors. At 1 year postoperatively, relative body weight ratio and postoperative serum albumin in the patients who experienced E-stasis was significantly lower than those in the other patients (P = 0.042 and 0.011, respectively). Of the patients who suffered from E-stasis, 42.5% experienced L-residue.

Conclusions

E-stasis after LPPG occurs in 7.6% of patients. Age, DM, and intraabdominal infection are significantly related to E-stasis. E-stasis is associated with poorer nutritional and functional outcomes even at 1 year postoperatively.

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References

  1. 1.

    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–E386386.

    CAS  Article  Google Scholar 

  2. 2.

    Sano T, Hollowood A. Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc. 2006;95(4):249–55.

    CAS  Google Scholar 

  3. 3.

    Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer. 2013;16(1):1–27.

    Article  Google Scholar 

  4. 4.

    Hiki N, Nunobe S, Kubota T, Jiang X. Function-preserving gastrectomy for early gastric cancer. Ann Surg Oncol. 2013;20(8):2683–92.

    Article  Google Scholar 

  5. 5.

    Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61(6):838–45.

    CAS  PubMed  Google Scholar 

  6. 6.

    Yokota T, Ishiyama S, Saito T, Teshima S, Shimotsuma M, Yamauchi H. Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. Lancet Oncol. 2003;4(7):423–8.

    Article  Google Scholar 

  7. 7.

    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.

    Article  Google Scholar 

  8. 8.

    Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, et al. Purely laparoscopic pylorus-preserving gastrectomy with extraperigastric lymphadenectomy for early gastric cancer: a case and technical report. Surg Laparosc Endosc Percutaneous Tech. 1999;9(6):418–22.

    CAS  Google Scholar 

  9. 9.

    Horiuchi T, Shimomatsuya T, Chiba Y. Laparoscopically assisted pylorus-preserving gastrectomy. Surg Endosc. 2001;15(3):325–8.

    CAS  Article  Google Scholar 

  10. 10.

    Shinohara H, Sonoda T, Niki M, Nomura E, Nishiguchi K, Tanigawa N. Laparoscopically-assisted pylorus-preserving gastrectomy with preservation of the vagus nerve. Eur J Surg (Acta chirurgica). 2002;168(1):55–8.

    Google Scholar 

  11. 11.

    Urushihara T, Sumimoto K, Shimokado K, Kuroda Y. Gastric motility after laparoscopically assisted distal gastrectomy, with or without preservation of the pylorus, for early gastric cancer, as assessed by digital dynamic X-ray imaging. Surg Endosc. 2004;18(6):964–8.

    CAS  Article  Google Scholar 

  12. 12.

    Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, et al. Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc. 2008;22(2):436–42.

    Article  Google Scholar 

  13. 13.

    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(5):928–33.

    Article  Google Scholar 

  14. 14.

    Kodama M, Koyama K, Chida T, Arakawa A, Tur G. Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer. World J Surg. 1995;19(3):456–60 (discussion 61).

    CAS  Article  Google Scholar 

  15. 15.

    Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, et al. Excellent long-term prognosis and favorable postoperative nutritional status after laparoscopic pylorus-preserving gastrectomy. Ann Surg Oncol. 2017;24(8):2233–40.

    Article  Google Scholar 

  16. 16.

    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(1):49–56.

    Article  Google Scholar 

  17. 17.

    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(12):2335–400.

    Article  Google Scholar 

  18. 18.

    Kumagai K, Hiki N, Nunobe S, Sekikawa S, Chiba T, Kiyokawa T, et al. Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes. Gastric Cancer. 2015;18(1):183–7.

    Article  Google Scholar 

  19. 19.

    Morita S, Sasako M, Saka M, Fukagawa T, Sano T, Katai H. Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy. Gastric Cancer. 2010;13(2):109–16.

    Article  Google Scholar 

  20. 20.

    Nishizawa N, Hosoda K, Moriya H, Mieno H, Ema A, Ushiku H, et al. Patients' preoperative background causes gastric stasis after laparoscopy-assisted pylorus-preserving gastrectomy. Asian J Endosc Surg. 2018;11(4):337–45.

    Article  Google Scholar 

  21. 21.

    Furukawa H, Ohashi M, Honda M, Kumagai K, Nunobe S, Sano T, et al. Preservation of the celiac branch of the vagal nerve for pylorus-preserving gastrectomy: is it meaningful? Gastric Cancer. 2018;21(3):516–23.

    Article  Google Scholar 

  22. 22.

    Hiki N, Kaminishi M. Pylorus-preserving gastrectomy in gastric cancer surgery-open and laparoscopic approaches. Langenbecks Arch Surg. 2005;390(5):442–7.

    Article  Google Scholar 

  23. 23.

    Ohashi M, Hiki N, Ida S, Kumagai K, Nunobe S, Sano T. A novel method of intracorporeal end-to-end gastrogastrostomy in laparoscopic pylorus-preserving gastrectomy for early gastric cancer, including a unique anastomotic technique: piercing the stomach with a linear stapler. Surg Endosc. 2018;32(10):4337–433.

    Article  Google Scholar 

  24. 24.

    Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5(2):83–9.

    Article  Google Scholar 

  25. 25.

    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12

    Article  Google Scholar 

  26. 26.

    Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    CAS  Article  Google Scholar 

  27. 27.

    Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668–85.

    Article  Google Scholar 

  28. 28.

    Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127(5):1592–622.

    Article  Google Scholar 

  29. 29.

    Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127(5):1589–91.

    Article  Google Scholar 

  30. 30.

    Neshatian L, Gibbons SJ, Farrugia G. Macrophages in diabetic gastroparesis–the missing link? Neurogastroenterol Motil Off J Eur Gastrointestinal Motil Soc. 2015;27(1):7–18.

    CAS  Article  Google Scholar 

  31. 31.

    Koch KL, Calles-Escandon J. Diabetic gastroparesis. Gastroenterol Clin N Am. 2015;44(1):39–57.

    Article  Google Scholar 

  32. 32.

    Yarandi SS, Srinivasan S. Diabetic gastrointestinal motility disorders and the role of enteric nervous system: current status and future directions. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2014;26(5):611–24.

    CAS  Article  Google Scholar 

  33. 33.

    Kaji S, Makuuchi R, Irino T, Tanizawa Y, Bando E, Kawamura T, et al. Preventive effect on delayed gastric emptying of preserving the infra-pyloric vein in laparoscopic pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc. 2019. https://doi.org/10.1007/s00464-019-07151-9

    Article  PubMed  Google Scholar 

  34. 34.

    Tomita R, Fujisaki S, Tanjoh K. Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg. 2003;27(6):725–33.

    Article  Google Scholar 

  35. 35.

    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(1):302–11.

    Article  Google Scholar 

  36. 36.

    Namikawa T, Hiki N, Kinami S, Okabe H, Urushihara T, Kawahira H, et al. Factors that minimize postgastrectomy symptoms following pylorus-preserving gastrectomy: assessment using a newly developed scale (PGSAS-45). Gastric Cancer. 2015;18(2):397–406.

    Article  Google Scholar 

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Correspondence to Manabu Ohashi.

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Takahashi, R., Ohashi, M., Hiki, N. et al. Risk factors and prognosis of gastric stasis, a crucial problem after laparoscopic pylorus-preserving gastrectomy for early middle-third gastric cancer. Gastric Cancer 23, 707–715 (2020). https://doi.org/10.1007/s10120-019-01037-4

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Keywords

  • Laparoscopic pylorus-preserving gastrectomy
  • Gastric stasis
  • Early gastric cancer and remnant stomach