Postoperative clinical evaluation following pylorus-preserving gastrectomy.
OBJECTIVE
Recent pathological study demonstrated that extended lymphadenectomy is not always necessary for patients with early gastric cancer.


METHODS
Twenty-eight patients underwent pylorus-preserving gastrectomy. The clinicopathological findings of patients with pylorus-preserving gastrectomy were compared to those of 58 patients with conventional distal gastrectomy.


RESULTS
There were no significant differences in surgical duration, blood loss, blood chemistry, food intake, and body weight loss. Regarding abdominal symptoms, early dumping syndrome was significantly higher in distal gastrectomy than in pylorus-preserving gastrectomy (35.6% vs. 12.0%, p<0.05). Remnant gastritis was also significantly higher in distal gastrectomy (57.1% vs. 27.7%, p<0.05). However, food residue tended to be more frequently seen in pylorus-preserving gastrectomy (33.3% vs. 61.1%, p=0.052). Based on questionnaire results, the rate of patient satisfaction with their surgical outcome tended to be lower in pylorus-preserving gastrectomy than in distal gastrectomy (84.0% vs. 95.6%, p=0.098). The tendency was more pronounced in patients over 70 years old (77.8% vs. 100%, p=0.065).


CONCLUSIONS
Pylorus-preserving gastrectomy is superior to conventional distal gastrectomy in the prevention of dumping syndrome and reflux gastritis. However, since delayed emptying is frequently seen post pylorus-preserving gastrectomy, this procedure is not recommended for older patients under simplistic indications.
Yamaguchi
Tomohiro
T
Department of Surgery, Kyoto First Red Cross Hospital, Kyoto, Japan.
Ichikawa
Daisuke
D
Kurioka
Hideaki
H
Ikoma
Hisashi
H
Koike
Hiroshi
H
Otsuji
Eigo
E
Ueshima
Yasuo
Y
Shioaki
Yasuhiro
Y
Lee
Chol Joo
CJ
Hamashima
Takashi
T
Deguchi
Eiichi
E
Ikeda
Eito
E
Mutoh
Fumitaka
F
Yamagishi
Hisakazu
H
D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011708:Pylorus; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*