J Minim Invasive Surg.  2019 Sep;22(3):113-118. 10.7602/jmis.2019.22.3.113.

A Comparison of Totally Laparoscopic Pylorus Preserving Gastrectomy and Laparoscopy-Assisted Pylorus Preserving Gastrectomy for Early Gastric Cancer

• Han WH
• Eom BW
• Yoon HM
• Ryu KW
• Kim DH
• Kim YW

• KMID: 2457658
• DOI: http://doi.org/10.7602/jmis.2019.22.3.113

Abstract

PURPOSE
Pylorus-preserving gastrectomy (PPG) is known to have both nutritional and functional advantages over distal gastrectomy for the treatment of early gastric cancer. Although laparoscopic surgery is a popular choice, intracorporeal anastomosis is a newly developed technique that is gaining popularity. This study aimed to determine any differences in the oncological, surgical, and functional outcomes of intracorporeal and extracorporeal anastomosis after PPG.
METHODS
A retrospective analysis was performed on 90 patients for cT1N0 gastric cancer who underwent laparoscopic pylorus preserving gastrectomy from January 2015 to June 2017 at the OOO, Korea; 38 patients underwent intracorporeal (TLPPG) and 52 underwent extracorporeal (LAPPG) anastomosis. The postoperative oncological, surgical, and functional outcomes were compared between the two groups. In order to compare the outcomes in obese patients, the postoperative and functional outcomes in patients with a BMI of ≥25, and in those with abdominal wall thickness measuring ≥28 mm, were evaluated.
RESULTS
The TLPPG group showed a significantly reduced wound size (4 cm (3~4) vs 5 cm (5~6), p<0.001) and had fewer wound complaints than the LAPPG group (0.0% vs 15.4%, p=0.01). Postoperative complications were not significantly different between the two groups. In the BMI ≥25 subgroup, the first flatus time after operation was shorter in the TLPPG group (2.9±0.5 vs 3.5±0.8 days, p=0.04).
CONCLUSION
The study demonstrates that both TLPPG and LAPPG are safe and feasible, and that there is a potential benefit for obese patients.

Keyword

Gastric cancer; Surgery; Anastomosis; Laparoscopy; Pylorus preserving gastrectomy

MeSH Terms

Abdominal Wall
Flatulence
Gastrectomy*
Humans
Korea
Laparoscopy
Postoperative Complications
Pylorus*
Retrospective Studies
Stomach Neoplasms*
Wounds and Injuries