Pylorus-preserving gastrectomy for early cancer involving the upper third

can we go higher?

Chun Chao Zhu, Hui Cao, Felix Berlth, Jia Xu, Shin Hoo Park, Hwi Nyeong Choe, Yun Suhk Suh, Seong Ho Kong, Hyuk-Joon Lee, Woo Ho Kim, Han-Kwang Yang

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Pylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach. Methods: We included all patients of the period 2013–2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postoperative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development. Results: Overall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p < 0.001), less blood loss (p = 0.002) and lower postoperative morbidity compared to TG. For lymph-node (LN) stations being resected in all groups, no difference was found in number of resected LN. Recurrence-free survival was similar for all groups. PPG showed advantages regarding postoperative body weight, hemoglobin, total protein, albumin in postoperative 6 and 12 month follow-up. Lowest decrease of abdominal fat area after 12 months was seen for PPG. Gallstone incidence was significantly lower after PPG compared to TG (p < 0.001). Conclusions: For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.

Original languageEnglish
Pages (from-to)881-891
Number of pages11
JournalGastric Cancer
Volume22
Issue number4
DOIs
StatePublished - 12 Jul 2019

Fingerprint

Pylorus
Gastrectomy
Neoplasms
Stomach Neoplasms
Lymph Nodes
Gallstones
Morbidity
Albumins
Stomach
Hemoglobins
Body Weight
Gastric Stump
Recurrence
Abdominal Fat

Keywords

  • Early gastric cancer
  • Outcomes
  • Pylorus-preserving gastrectomy
  • Upper stomach

Cite this

Zhu, Chun Chao ; Cao, Hui ; Berlth, Felix ; Xu, Jia ; Park, Shin Hoo ; Choe, Hwi Nyeong ; Suh, Yun Suhk ; Kong, Seong Ho ; Lee, Hyuk-Joon ; Kim, Woo Ho ; Yang, Han-Kwang. / Pylorus-preserving gastrectomy for early cancer involving the upper third : can we go higher?. In: Gastric Cancer. 2019 ; Vol. 22, No. 4. pp. 881-891.
@article{5dd2dddd53ed4cca854d59ddd59023b9,
title = "Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?",
abstract = "Background: Pylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach. Methods: We included all patients of the period 2013–2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postoperative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development. Results: Overall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p < 0.001), less blood loss (p = 0.002) and lower postoperative morbidity compared to TG. For lymph-node (LN) stations being resected in all groups, no difference was found in number of resected LN. Recurrence-free survival was similar for all groups. PPG showed advantages regarding postoperative body weight, hemoglobin, total protein, albumin in postoperative 6 and 12 month follow-up. Lowest decrease of abdominal fat area after 12 months was seen for PPG. Gallstone incidence was significantly lower after PPG compared to TG (p < 0.001). Conclusions: For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.",
keywords = "Early gastric cancer, Outcomes, Pylorus-preserving gastrectomy, Upper stomach",
author = "Zhu, {Chun Chao} and Hui Cao and Felix Berlth and Jia Xu and Park, {Shin Hoo} and Choe, {Hwi Nyeong} and Suh, {Yun Suhk} and Kong, {Seong Ho} and Hyuk-Joon Lee and Kim, {Woo Ho} and Han-Kwang Yang",
year = "2019",
month = "7",
day = "12",
doi = "10.1007/s10120-018-00921-9",
language = "English",
volume = "22",
pages = "881--891",
journal = "Gastric Cancer",
issn = "1436-3291",
publisher = "Springer Japan",
number = "4",

}

Pylorus-preserving gastrectomy for early cancer involving the upper third : can we go higher? / Zhu, Chun Chao; Cao, Hui; Berlth, Felix; Xu, Jia; Park, Shin Hoo; Choe, Hwi Nyeong; Suh, Yun Suhk; Kong, Seong Ho; Lee, Hyuk-Joon; Kim, Woo Ho; Yang, Han-Kwang.

In: Gastric Cancer, Vol. 22, No. 4, 12.07.2019, p. 881-891.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Pylorus-preserving gastrectomy for early cancer involving the upper third

T2 - can we go higher?

AU - Zhu, Chun Chao

AU - Cao, Hui

AU - Berlth, Felix

AU - Xu, Jia

AU - Park, Shin Hoo

AU - Choe, Hwi Nyeong

AU - Suh, Yun Suhk

AU - Kong, Seong Ho

AU - Lee, Hyuk-Joon

AU - Kim, Woo Ho

AU - Yang, Han-Kwang

PY - 2019/7/12

Y1 - 2019/7/12

N2 - Background: Pylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach. Methods: We included all patients of the period 2013–2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postoperative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development. Results: Overall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p < 0.001), less blood loss (p = 0.002) and lower postoperative morbidity compared to TG. For lymph-node (LN) stations being resected in all groups, no difference was found in number of resected LN. Recurrence-free survival was similar for all groups. PPG showed advantages regarding postoperative body weight, hemoglobin, total protein, albumin in postoperative 6 and 12 month follow-up. Lowest decrease of abdominal fat area after 12 months was seen for PPG. Gallstone incidence was significantly lower after PPG compared to TG (p < 0.001). Conclusions: For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.

AB - Background: Pylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach. Methods: We included all patients of the period 2013–2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postoperative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development. Results: Overall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p < 0.001), less blood loss (p = 0.002) and lower postoperative morbidity compared to TG. For lymph-node (LN) stations being resected in all groups, no difference was found in number of resected LN. Recurrence-free survival was similar for all groups. PPG showed advantages regarding postoperative body weight, hemoglobin, total protein, albumin in postoperative 6 and 12 month follow-up. Lowest decrease of abdominal fat area after 12 months was seen for PPG. Gallstone incidence was significantly lower after PPG compared to TG (p < 0.001). Conclusions: For EGC involving the upper third, PPG can be another good option with lower postoperative morbidity, better functional outcomes, and same oncological safety.

KW - Early gastric cancer

KW - Outcomes

KW - Pylorus-preserving gastrectomy

KW - Upper stomach

UR - http://www.scopus.com/inward/record.url?scp=85061752831&partnerID=8YFLogxK

U2 - 10.1007/s10120-018-00921-9

DO - 10.1007/s10120-018-00921-9

M3 - Article

VL - 22

SP - 881

EP - 891

JO - Gastric Cancer

JF - Gastric Cancer

SN - 1436-3291

IS - 4

ER -