Reappraisal of Pylorus-Preserving Gastrectomy for Early Gastric Cancer in the Era of Laparoscopic Surgery : Its Indication and Early Outcome
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INTRODUCTION: Pylorus-preserving gastrectomy （PPG）, which had been developed in 1960s, has been reappraised for years and now accepted as a type of function-preserving compared with those of laparoscopy-assisted distal gastrectomy （LADG）,which does not preserve the pylorus and involves resection of the suprapyloric lymph nodes.METHODS: Ninety six patients diagnosed as having gastric cancer of cT1N0 underwent either LADG （n=66） orLAPPG （n=30）. The patient demographics and the early surgical outcomes were evaluated retrospectively. Thequality of lymph node dissection in LAPPG was also assessed pathologically.RESULTS: Among 96 patients preoperatively diagnosed as cT1, pT1 was 88 cases and pT2 in 8, 91.7 % of diagnosticaccuracy. There were no differences in patient demographics, operative time, blood loss, the number of dissectedlymph nodes, postoperative morbidity and length of hospitalization. Pathologically, the number of dissected lymphnodes at No. 3, 4, 6 were equal between the two groups. Among our LADG cases, 35（ 53%） were lesions confined tothe mucosa with a distance between the pylorus and the anal margin of the tumor <4 cm.CONCLUSIONS: Our initial experience suggests that LAPPG can be performed with acceptable quality of lymphnode dissection and early surgical outcome. Because LAPPG was thought to be applied for about a half of our LADGcases according to the new guideline, LAPPG is expected to be indicated for more cases with early gastric cancer asa function-preserving limited surgery.
- 2011-12-26
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