Yonago Acta medica 2008;51:25–30
Laparoscopy-Assisted Pylorus-Preserving Gastrectomy for Treating Early Gastric Cancer
Hiroaki Saito, Yoji Fukumoto, Tomohiro Osaki, Yoshinori Yamada, Kenji Fukuda, Shigeru Tatebe, Shunichi Tsujitani and Masahide Ikeguchi
Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with lymphadenectomy has been used for treating early gastric cancer located in the middle-third of the stomach. However, firm evidence supporting its safety and usefulness is scant. This study examined 24 and 10 gastric adenocarcinoma patients who had undergone conventional pylorus-preserving gastrectomy (CPPG) and LAPPG, respectively, at our institution. Operation time for LAPPG (362.8 ± 49.6 min) was significantly longer than that for CPPG (221.9 ± 50.0 min; P=0.04). Estimated blood loss with LAPPG (127.5 ± 91.2 mL) was not significantly different from that with CPPG (167.9 ± 149.9 mL; P=0.44). Total number of resected lymph nodes was 26.3 ± 9.5 and 21.3 ± 10.8 with LAPPG and CPPG, respectively, with no statistically significant difference. C-reactive protein in serum on postoperative day 1 was significantly lower in the LAPPG than in the CPPG group (5.3 ± 1.7 mg/dL versus 7.8 ± 3.6 mg/dL; P=0.049). The requirement for analgesia after surgery was more frequent in the CPPG than in the LAPPG group (3.7 ± 2.0 versus 2.2 ± 1.7; P=0.04). Time to first flatus was shorter in the LAPPG than in the CPPG group (1.9 ± 0.9 days versus 3.1 ± 0.9 days; P=0.0006). Postoperative hospital stay was significantly shorter in the LAPPG than in the CPPG group (12.0 ± 4.0 days versus 23.0 ± 10.7days; P=0.0036). With regard to postoperative complications, stasis was observed more frequently in the CPPG (33.3%) than in the LAPPG (10%) group. In conclusion, patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by CPPG.
Key words: early gastric cancer; laparoscopy-assisted pylorus-preserving gastrectomy; pylorus preservation
