PYLORUS PRESERVATION FOR MIDDLE GASTRIC CANCER 

NEW YORK (Reuters Health) May 28 - A pylorus-preserving gastrectomy is better than a distal gastrectomy for middle-third early gastric cancers, Korean researchers report.

A Japanese researcher who wasn't involved in the study agrees. "I really think the laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) should be a standard treatment for patients with early gastric cancer of middle-third of the stomach," said Dr. Naoki Hiki from Cancer Institute Hospital, Tokyo, in an email to Reuters Health.

Dr. Hiki, among many others, has published on treatment for gastric cancer, but few studies have compared outcomes with LAPPG or laparoscopy-assisted distal gastrectomy (LADG) for middle-third early gastric cancer.

To address this gap, Dr. Han-Kwang Yang from Seoul National University College of Medicine, Seoul, Korea and colleagues retrospectively compared 176 patients who underwent LADG and 116 who underwent LAPPG.

The two were equivalent in terms of surgical and oncologic safety, the researchers concluded. But LAPPG, they found, "has nutritional and functional advantages over LADG."

Operating time was significantly shorter with LAPPG (mean, 193.8 vs 216.57 min; p<0 .001="" 6th="" and="" annals="" authors="" between="" but="" examined="" groups="" in="" lymph="" may="" metastatic="" nodes="" numbers="" of="" online="" p="" reported="" similar="" size="" surgery.="" the="" tumor="" were="">

The two groups did not differ in overall postoperative morbidity, but delayed gastric emptying affected a significantly higher proportion of patients in the LAPPG group (7.8% vs 1.7%; p=0.015). All affected patients, however, had successful radiologic balloon dilatation.

Other than delayed gastric emptying, complications developed more frequently after LADG vs LAPPG (17.0% vs 7.8%; p=0.023). There were no perioperative deaths in either group.

Two patients in each group had recurrence (but not at the anastomotic site or locoregional lymph nodes). The three-year recurrence-free survival rates were similar for LAPPG (98.2%) and LADG (98.8%).

During follow-up, LADG patients had the greater mean reductions in visceral, total, and subcutaneous abdominal fat area.

During the first six months after surgery (but not in months seven to 12), serum concentrations of protein and albumin were significantly higher in the LAPPG group.

No one developed gallstones after LAPPG, but eight patients did after LADG (6.5%; p=0.038).

"Because I have considerable experience with LAPPG, I do not find these results surprising," Dr. Hiki said. "I also published similar outcomes in the Annals of Surgery in 2011."

"PPG prevents postprandial symptoms such as dumping syndrome, body weight loss, gallstones, and alkaline reflux," Dr. Hiki added. "However, delayed gastric retention due to aberrant pyloric function can occur during the early postoperative period. To prevent postoperative complications, surgeons need to ensure an extra learning period for LAPPG."

Dr. Yang did not respond to a request for comments on this report.

SOURCE: http://bit.ly/18r9Z7i

Ann Surg 2013.