Step-by-Step Description of Pylorus-Preserving Gastrectomy

  • Felix Berlth
  • Naoki Hiki
  • Han-Kwang YangEmail author


Since a high proportion of early gastric cancers are diagnosed in Japan and Korea, surgical strategies have been developed to preserve postoperative function without oncological compromise. Pylorus-preserving gastrectomy (PPG) in this manner is a good option for clinically early gastric cancers of the middle portion of the stomach. When preserving a substantial proportion of the stomach with sufficient blood supply, including junctional area and pylorus, the postoperative course is expected to improve in comparison to distal gastrectomy. As long-term outcomes suggest its oncological safety, recent prospective trials aim for nutritional aspects and quality of life in the follow-up period. Postoperative malfunction of the pylorus can compromise the functional outcome of PPG significantly, but there are several technical aspects to be considered during surgery in order to avoid complications related to this issue. This chapter summarizes the background of the PPG operation and explains the resection and different approaches for reconstruction in a step-by-step manner.


Pylorus-preserving gastrectomy Laparoscopic gastrectomy Robotic gastrectomy Gastric cancer Minimally-invasive surgery Partial gastrectomy 

Supplementary material

Video 6.1

Robotic-assisted pylorus-preserving gastrectomyRobotic-assisted pylorus-preserving gastrectomy (MP4 5706450 kb)


  1. 1.
    Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRefGoogle Scholar
  2. 2.
    Hiki N, Sano T, Fukunaga T, et al. Survival benefit of pylorus-preserving gastrectomy in early gastric cancer. J Am Coll Surg. 2009;209:297–301.CrossRefGoogle Scholar
  3. 3.
    Suh YS, Han DS, Kong SH, 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.CrossRefGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.CrossRefGoogle Scholar
  5. 5.
    Katai H, Mizusawa J, Katayama H, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20:699–708.CrossRefGoogle Scholar
  6. 6.
    Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263:28–35.CrossRefGoogle Scholar
  7. 7.
    Han D-S, Suh Y-S, Ahn HS, 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.CrossRefGoogle Scholar
  8. 8.
    Haruta S, Shinohara H, Ueno M, et al. Anatomical considerations of the infrapyloric artery and its associated lymph nodes during laparoscopic gastric cancer surgery. Gastric Cancer. 2015;18:876–80.CrossRefGoogle Scholar
  9. 9.
    Kiyokawa T, Hiki N, Nunobe S, et al. Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy. Langenbeck’s Arch Surg. 2017;402:49–56.CrossRefGoogle Scholar
  10. 10.
    Kong SH, Kim JW, Lee HJ, et al. The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy. Ann Surg Oncol. 2009;16:3252–8.CrossRefGoogle Scholar
  11. 11.
    Tsujiura M, Hiki N, Ohashi M, et al. “Pancreas-compressionless gastrectomy”: a novel laparoscopic approach for suprapancreatic lymph node dissection. Ann Surg Oncol. 2017;24:3331–7.CrossRefGoogle Scholar
  12. 12.
    Zhu C-C, Kim T-H, Berlth F, et al. Clinical outcomes of intraoperative manual dilatation of pylorus in pylorus-preserving gastrectomy: a retrospective analysis. Gastric Cancer. 2018;21:864. Scholar
  13. 13.
    Kawakatsu S, Ohashi M, Hiki N, et al. Use of endoscopy to determine the resection margin during laparoscopic gastrectomy for cancer. Br J Surg. 2017;104:1829–36.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Surgery, Division of Gastrointestinal SurgerySeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of General, Visceral and Cancer SurgeryUniversity Hospital of CologneCologneGermany
  3. 3.Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineKanagawaJapan

Personalised recommendations