title: Current status of pylorus-preserving gastrectomy for the treatment of gastric cancer: a questionnaire survey and review of literatures.
abstract: OBJECTIVE
  This study was designed to investigate the current status of pylorus-preserving gastrectomy (PPG) for the treatment of gastric cancer by sending a questionnaire to institutions in Japan.
  
  
  METHODS
  The questionnaire was prepared and sent to 930 institutions approved by the Japanese Society of Gastroenterological Surgery. Questions were the indications for PPG, preservation of the vagus nerves and the infra-pyloric artery, whether suprapyloric lymph nodes are dissected, distance between the pylorus and the gastrogastrostomy, and the advantages and disadvantages of PPG.
  
  
  RESULTS
  Responses were obtained from 345 institutions (37.1%). In 148 institutions, PPG was included in the choices of operations for gastric cancer and indicated for patients with tumors no deeper than the submucosal layer for differentiated-type carcinoma, or for tumors limited to the mucosa even in poorly differentiated types in 105 institutions. The vagus was preserved in 73.5%, the infrapyloric artery was preserved in 49.4%, and the dissection of suprapyloric lymph nodes were partly performed in 56.2%. The distance between gastrogastrostomy and the pyloric ring was 3-3.9 cm in 43.4% and 2-2.9 cm in 39%. Layer-to-layer anastomosis was the most representative technique for gastrogastrostomy. The advantages of PPG with decreased incidence of dumping syndrome and remnant gastritis were quoted in 130 and 82 institutions, respectively. Delayed gastric emptying was considered as the most frequent disadvantage of PPG, as quoted by 111 institutions.
  
  
  CONCLUSIONS
  These results indicate that standard technique in PPG includes the preservation of the vagus and infrapyloric artery, in part dissection of suprapyloric lymph nodes, and layer-to-layer anastomosis for reconstruction. The optimal length of the antral cuff is still controversial.
authors.affiliation: Division of Biological Regulation and Oncology, Department of Surgery, Tohoku University Postgraduate School of Medicine, 1-1 Seriyo-machi, Aoba-ku, Sendai, 980-8574, Japan. cshibata@surg1.med.tohoku.ac.jp
authors.forename: Chikashi
authors.initials: C
authors.lastname: Shibata
authors.forename: Fumito
authors.initials: F
authors.lastname: Saijo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kakyo
authors.forename: Makoto
authors.initials: M
authors.lastname: Kinouchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Iwao
authors.initials: I
authors.lastname: Sasaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou
mesh_terms: D005743:Gastrectomy / Q000379:methods* / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D011708:Pylorus / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery; D011795:Surveys and Questionnaires