Feasibility of pylorus-preserving gastrectomy with a wider scope of lymphadenectomy.

Abstract

DUMPING syndromes and alkaline reflux gastritis comprise most of the postgastrectomy syndromes,^1,2 and these disorders sometimes result in patients having restricted food intake, rapid weight loss, and malnutrition, as well as the development of gastric remnant cancer.^1-6 For the treatment of early gastric cancer, efforts to minimize postoperative morbidity and mortality and to obtain a better quality of life following surgical therapy have increased because the survival rates of early gastric cancer following radical gastrectomy have already reached around 95%.⁷ On this basis, several types of limited surgical interventions^7,8 for early gastric cancer have been developed in Japan without decreasing the survival rates. Pylorus-preserving gastrectomy (PPG), which was originally applied to the treatment of peptic ulcer with satisfactory results,^9,10has become one of the treatment modalities of limited surgical therapy for early gastric cancer¹¹ to avoid the dumping syndromes and bile fluid regurgitation. Although the previously reported PPG procedures^12,13 were demonstrated to have postoperative functional benefits, incomplete suprapyloric lymph node dissection to preserve the right gastric artery and the pyloric branch of the vagus nerve by these procedures resulted in limited indications for the PPG.^12,13 Recent investigations showing that the right gastric artery and the pyloric branch of the vagus nerve could be divided without affecting the blood flow or motility of the pylorus suggest the possibility of a complete perigastric lymphadenectomy with PPG.^14,15 However, postoperative evaluation of the PPG procedure with suprapyloric lymph node dissection has not been undertaken. This study demonstrates that a PPG procedure accompanied by suprapyloric lymph node dissection is superior to conventional distal gastrectomy (CDG) with Billroth I reconstruction and indicates that this procedure can be performed without any major complications. These findings also imply that the complete D2 lymphadenectomy can be performed with PPG and that wider application of PPG for early gastric cancer is feasible.