Pylorus-Preserving Gastrectomy with Selective Lymphnodal Dissection in Early Gastric Cancer

ABSTRACT

The major purpose of this study was to assess the post-operative quality of life after performing a pylorus-preserving gastrectomy (PPG) in early gastric cancer patients, comparing the results with patients who underwent a conventional gastrectomy (CG). There were 48 patients with gastric cancer who underwent surgical intervention at the Department of Surgery, Taejon St. Mary's Hospital, The Catholic University of Korea School of Medicine from November 1995 through June 1996. Out of 48 gastric cancer patients, 13 patients (27.1 %) were early gastric cancers. Seven patients of these 13 patients underwent a PPG and the others underwent a CG. The indications for PPG were ; 1) a lesion at least 5 cm proximal to the pyloric ring, 2) a lesion in the middle third of the stomach, 3) a lesion less than 40 mm in maximum length, and 4) especially a lesion located at the greater curvature. Localization of the lesion was precisely performed through a gastrotomy during the operation. Dissections of the No. 7, 8, and 9 nodes (D1 +) were performed in cases of ulcerated lesions (type III) or poorly differentiated lesions. The proximal and distal portions of the stomach were anastomosed together 2-3 cm proximal to the pyloric ring to preserve the pyloric function. Gastrografin studies were performed on the sixth or the seventh day following PPG, and disclosed that the pylori were almost normal in appearance and function. Compared to a CG, the duration of nasogastric decompression was longer by one day, the start of oral feeding was delayed by two days, and the duration of the hospital stay was longer by five days after PPG. Three months following PPG, the amount of food taken in a meal was 70-90 % compared to that of the pre-operative amount, oral feedings took place three to four times a day, and the performance status was excellent (grade 0). Endoscopic examination revealed two cases of food stasis without subjective symptoms and a case of bile reflux with minimal mucosal edema after the PPG. After the CG, three out of the six cases had bile reflux with mucosal redness and erosion. In conclusion, it seemed that for early gastric cancer a pylorus-preserving gastrectomy, with selective lymphnodal dissection, was superior to the standard operation in terms of post-operative quality of life.