Pylorus-Preserving Gastrectomy for Gastric Cancer - KoreaMed Synapse

pISSN : 2093-582X, eISSN : 2093-5641 J Gastric Cancer 2016;16(2):63-71  http://dx.doi.org/10.5230/jgc.2016.16.2.63

Review Article

Pylorus-Preserving Gastrectomy for Gastric Cancer Seung-Young Oh1, Hyuk-Joon Lee1,2, and Han-Kwang Yang1,2 1

Department of Surgery and 2Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and longterm oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopyassisted PPG (LAPPG) from the patient’s perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG. Key Words: Pylorus-preserving gastrectomy; Stomach neoplasms; Review

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Introduction

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Correspondence to: Hyuk-Joon Lee Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-1957, Fax: +82-2-766-3975 E-mail: [email protected] Received May 19, 2016 Accepted May 23, 2016

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This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyrights © 2016 by The Korean Gastric Cancer Association

www.jgc-online.org

64 Oh SY, et al.

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Indications and Surgical Techniques

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1. Indications

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2. Length of the antral cuff

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Methods

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Table 1. Early experiences of pylorus-preserving gastrectomy Author

Institute

No. of cases

Year

Pyloric branch of the vagus nerve & RGA

Length of the antral segment (cm)

Kodama et al.14

Akita University

35

1989~1991

Preserved

1.5

Zhang et al.16

University of Tokyo

15

1993~1995

Divided

1.5

Imada et al.15

Yokohama University

20

1992~1996

Preserved

1.5

26

Tomita et al.

Nihon University

10

1993~1996

Divided

1.5

Nakane et al.17

Kansai University

30

1993~1999

Preserved

1.5 versus 2.5

Hotta et al.19

Wakayama University

19

1995~1998

Preserved

1.5

24

Ohya et al.

Gumma University

Nunobe et al.10

National Cancer Center

Nagano et al.22 23

Nishikawa et al.

27

13

1995~1998

Preserved

2.0

194

1993~1999

Preserved

2.5~6.0

Fukui University

72

1991~2000

Preserved

-

Osaka University

12

1997~2000

Preserved

1.5

Urushihara et al.

Yoshida General Hospital

26

1998~2002

Preserved

3.0

Park et al.11

Seoul National University

22

1999~2003

Preserved

3.0

611

1995~2004

Preserved

2.0

Morita et al.21

National Cancer Center 25

Tomikawa et al.

Fukuoka City Hospital

9

2004~2007

Preserved

3.0

Lee et al.20

Osaka Medical College

12

2000~2009

NA

≥4.0

RGA = right gastric artery; NA = not available.

65 Pylorus-Preserving Gastrectomy

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3. Lymph node metastasis around the pylorus

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5. Laparoscopic pylorus-preserving gastrectomy

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