Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2017

01-08-2017 | Gastrointestinal Oncology

Excellent Long-Term Prognosis and Favorable Postoperative Nutritional Status After Laparoscopic Pylorus-Preserving Gastrectomy

Authors: Masahiro Tsujiura, MD, PhD, Naoki Hiki, MD, PhD, Manabu Ohashi, MD, PhD, Souya Nunobe, MD, PhD, Koshi Kumagai, MD, PhD, Satoshi Ida, MD, PhD, Masaru Hayami, MD, PhD, Takeshi Sano, MD, PhD, Toshiharu Yamaguchi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2017

Login to get access

Abstract

Background

Laparoscopic pylorus-preserving gastrectomy (LPPG) has been introduced as a minimally invasive function-preserving operation for early gastric cancer (GC). This study aimed to investigate the surgical and prognostic outcomes after LPPG at the authors’ institution.

Methods

This study analyzed 465 patients who underwent LPPG for cT1 N0 GC located in the middle part of the stomach between 2006 and 2012. Short- and long-term surgical outcomes including 5-year survival rates, postoperative nutritional data, and body weight change were retrospectively investigated.

Results

Regarding short-term surgical results, 14 (3%) of the 465 patients had severe complications classified as Clavien–Dindo grade 3a or above, and no mortality occurred (no in-hospital deaths). The median follow-up period was 1829 days (range 226–3197 days), and the 5-year overall survival and relapse-free survival rates were respectively 98% (95% confidence interval [CI] 96.1–99.0%) and 98% (95% CI 96.1–99.0%). Only two cases of postoperative recurrence were confirmed, and their recurrence sites were not in the remnant stomach or regional lymph nodes. The postoperative nutritional status, in terms of serum total protein, albumin, and hemoglobin levels, was well maintained, and the mean relative body weight (postoperative/preoperative) was 93.24 ± 7.29% after LPPG.

Conclusions

For the first time, we have clarified the detailed long-term survival outcomes of LPPG for cT1 N0 GC. LPPG is an acceptable and favorable operative method for clinically diagnosed early-stage GC, in terms of long-term survival and postoperative nutrition.
Literature
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.CrossRefPubMed
2.
3.
Sano T, Hollowood A. Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg. 2006;95:249–55.CrossRefPubMed
4.
Nashimoto A, Akazawa K, Isobe Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer. 2013;16:1–27.CrossRefPubMed
5.
Hiki N, Nunobe S, Kubota T, Jiang X. Function-preserving gastrectomy for early gastric cancer. Ann Surg Oncol. 2013;20:2683–92.CrossRefPubMed
6.
Hyun MH, Lee CH, Kim HJ, Tong Y, Park SS. Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma. Br J Surg. 2013;100:1566–78.CrossRefPubMed
7.
Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61:838–45.PubMed
8.
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;4:423–28.CrossRefPubMed
9.
Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.
10.
Hotta T, Taniguchi K, Kobayashi Y, et al. Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer. Surg Today. 2001;31:774–79.CrossRefPubMed
11.
Yamaguchi T, Ichikawa D, Kurioka H, et al. Postoperative clinical evaluation following pylorus-preserving gastrectomy. Hepatogastroenterology. 2004;51:883–86.
12.
Parkdo J, 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.CrossRefPubMed
13.
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.CrossRefPubMed
14.
Kim BH, Hong SW, Kim JW, Choi SH, Yoon SO. Oncologic safety of pylorus-preserving gastrectomy in the aspect of micrometastasis in lymph nodes at stations 5 and 6. Ann Surg Oncol. 2014;21:533–38.CrossRefPubMed
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;95:1131–35.CrossRefPubMed
16.
Ikeguchi M, Hatada T, Yamamoto M, 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.CrossRefPubMed
17.
Matsuki A, Nashimoto A, Yabusaki H, Nakagawa S. Long-term clinical outcome and survival after pylorus-preserving gastrectomy. Hepatogastroenterology. 2012;59:2012–15.PubMed
18.
Fukunaga T, Hiki N, Kubota T, et al. Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:2676–82.CrossRefPubMed
19.
Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M. Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg. 2006;203:162–9.CrossRefPubMed
20.
Jiang X, Hiki N, Nunobe S, et al. Long-term outcome and survival with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc. 2011;25:1182–6.CrossRefPubMed
21.
Jiang X, Hiki N, Nunobe S, et al. Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg. 2011;253:928–33.CrossRefPubMed
22.
Hiki N, Kaminishi M. Pylorus-preserving gastrectomy in gastric cancer surgery–open and laparoscopic approaches. Langenbecks Arch Surg. 2005;390:442–7.CrossRefPubMed
23.
Kumagai K, Hiki N, Nunobe S, et al. Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes. Gastric Cancer. 2015;18:183–7.CrossRefPubMed
24.
Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.
25.
Sobin L, Gospodarowicz MK, Wittekind C, eds. International Union Against Cancer TNM Classification of Malignant Tumours, 7th ed. Oxford, UK: Wiley-Blackwell; 2009.
26.
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.CrossRefPubMedPubMedCentral
27.
Hiki N, Sano T, Fukunaga T, Ohyama S, Tokunaga M, Yamaguchi T. Survival benefit of pylorus-preserving gastrectomy in early gastric cancer. J Am Coll Surg. 2009;209:297–301.CrossRefPubMed
28.
Shibata C, Shiiba KI, Funayama Y, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg. 2004;28:857–61.CrossRefPubMed
29.
Annibale B, Capurso G, Delle Fave G. The stomach and iron deficiency anaemia: a forgotten link. Dig Liver Dis. 2003;35:288–95.CrossRefPubMed
30.
Imada T, Rino Y, Takahashi M, et al. Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery. 1998;123:165–70.CrossRefPubMed
31.
Kodama M, Koyama K, Chida T, Arakawa A, Tur G. Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer. World J Surg. 1995;19:456–60 (discussion 461).CrossRefPubMed
32.
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.CrossRefPubMed
33.
Fujita J, Takahashi M, Urushihara 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.CrossRefPubMed
34.
Lee MS, Ahn SH, Lee JH, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc. 2012;26:1539–47.CrossRefPubMed
35.
Terashima M, Tanabe K, Yoshida M, et al. Postgastrectomy Syndrome Assessment Scale (PGSAS)-45 and changes in body weight are useful tools for evaluation of reconstruction methods following distal gastrectomy. Ann Surg Oncol. 2014;21:S370–8.CrossRefPubMed
Metadata
Title
Excellent Long-Term Prognosis and Favorable Postoperative Nutritional Status After Laparoscopic Pylorus-Preserving Gastrectomy
Authors
Masahiro Tsujiura, MD, PhD
Naoki Hiki, MD, PhD
Manabu Ohashi, MD, PhD
Souya Nunobe, MD, PhD
Koshi Kumagai, MD, PhD
Satoshi Ida, MD, PhD
Masaru Hayami, MD, PhD
Takeshi Sano, MD, PhD
Toshiharu Yamaguchi, MD, PhD
Publication date
01-08-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5828-0

Other articles of this Issue 8/2017

Annals of Surgical Oncology 8/2017 Go to the issue

Colorectal Cancer

Is Fecal Diversion Needed in Pelvic Anastomoses During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?

Reconstructive Oncology

Reconstruction Outcomes of Oncologic Foot Defect Using Well-Contoured Free Perforator Flaps

Gastrointestinal Oncology

A Prognostic Model for Predicting Overall Survival in Patients with Peritoneal Surface Malignancy of an Appendiceal Origin Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Endocrine Tumors

The Effect of Prophylactic Central Neck Dissection on Locoregional Recurrence in Papillary Thyroid Cancer After Total Thyroidectomy: A Systematic Review and Meta-Analysis

Health Services Research and Global Oncology

Exploring the Underlying Mechanisms of the Volume–Outcome Relationship in Complex Cancer Care

Gastrointestinal Oncology

Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy