title: Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach.
abstract: OBJECTIVE
  Patients diagnosed with early gastric cancer located in the middle third of the stomach have two major surgical options, namely a conventional distal gastrectomy with Billroth I anastomosis (DG) or a pylorus-preserving gastrectomy (PPG). Pyloruspreserving gastrectomy is thought to have greater functional benefits than DG, but the evaluation of its prognosis and outcome has so far been insufficient.
  
  
  METHODS
  Between 1997 and 2007, 133 patients were diagnosed with early gastric cancer located in the middle third of the stomach. Distal gastrectomy was performed in 87 and PPG was performed in 46 of these patients. The clinicopathological characteristics were compared between the groups.
  
  
  RESULTS
  There were fewer dissected lymph nodes in PPG (mean: 21.9) than in DG (mean: 30.4, P = 0.001). Complications were detected in 16.1% of DG patients and in 6.5% of PPG patients. The occurrence of stasis after PPG (6.5%) was similar to that observed after DG (6.9%). One patient in the DG group died from cancer recurrence, but cancer recurrence was not detected in the PPG group. Although the difference was not significant, the overall 5-year survival rate in the 46 PPG patients (95%) was better than that in the 87 DG patients (86%, P = 0.087).
  
  
  CONCLUSIONS
  Pylorus-preserving gastrectomy patients had fewer postoperative complications than DG patients. The long-term follow-up of these patients will clarify the nutritional and prognostic benefits of PPG.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Ikeguchi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hatada
authors.forename: Manabu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Takanori
authors.initials: T
authors.lastname: Miyake
authors.forename: Tomonori
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Saito
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tatebe
mesh_terms: D055088:Early Detection of Cancer; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome