Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2019; 25(36): 5494-5504
Published online Sep 28, 2019. doi: 10.3748/wjg.v25.i36.5494
Laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer: A retrospective study of long-term functional outcomes and quality of life
Bang Wool Eom, Boram Park, Hong Man Yoon, Keun Won Ryu, Young-Woo Kim
Bang Wool Eom, Hong Man Yoon, Keun Won Ryu, Young-Woo Kim, Center for Gastric Cancer, National Cancer Center, Goyang 10408, South Korea
Boram Park, Biostatistics Collaboration Team, Research Core, Research institute, National Cancer Center, Goyang 10408, South Korea
Author contributions: Eom BW and Kim YW designed the study; Eom BW, Yoon HM, Ryu KW, and Kim YW treated patients and collected material and clinical data from the patients; Eom BW, Park B analyzed data; Eom BW wrote the paper; Yoon HM, Ryu KW, and Kim YW reviewed and finally approved the manuscript.
Supported by the National Cancer Center, No. NCC-1810304-1 and No. 1710120-1.
Institutional review board statement: The study was approved by the institutional review board of the Korean National Cancer Center (No. NCC2017-0183).
Informed consent statement: The institutional review board of the Korean National Cancer Center waived the requirement to obtain informed consents from patients.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
STROBE statement: This study adopted the guidelines of the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Young-Woo Kim, MD, PhD, Professor, Surgeon, Center for Gastric Cancer, National Cancer Center, Ilsan-ro 323, Ilsandong-gu, Goyang-si, Goyang 10408, South Korea. gskim@ncc.re.kr
Telephone: +82-31-9201635 Fax: +82-31-9200696
Received: May 31, 2019
Peer-review started: May 31, 2019
First decision: July 21, 2019
Revised: August 8, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: September 28, 2019
Processing time: 121 Days and 1.9 Hours
ARTICLE HIGHLIGHTS
Research background

Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was known to have benefits of function-preserving surgery compared to laparoscopy-assisted distal gastrectomy (LADG). However, in clinical settings, delayed gastric emptying and esophageal reflux following LAPPG can be serious issues, making surgeons reluctant to perform LAPPG.

Research motivation

It is unclear that LAPPG had better long-term functional outcomes and quality of life compared to LADG.

Research objectives

To evaluate the long-term functional outcomes and patient-reported quality of life of LAPPG compared to those of LADG with Billroth II anastomosis.

Research methods

We reviewed the clinicopathological data of 195 patients who underwent LADG with Billroth II anastomosis and 101 patients who underwent LAPPG for cT1N0 gastric cancer in the middle third of the stomach between 2012 and 2015. Postoperative complications, nutritional parameters, and survey results of the EORTC QLQ C30 and STO22 questionnaire were compared between the two groups.

Research results

The serum hemoglobin level was significantly higher in the LAPPG group than in the LADG group (P < 0.001). In the endoscopic findings, incidence of bile reflux was lower (P < 0.001); however, the incidence of residual food was higher in the LAPPG group than in the LADG group (P < 0.001). Regarding the quality of life score, the LAPPG group had a better physical functioning score (86.7 vs 90.0, P = 0.032) but also greater pain and reflux when compared to the LADG group (8.3 vs 16.7 in pain, 11.1 (interquartile range, 0, 22.2) vs 11.1 (interquartile range, 11.1, 33.3) in reflux, P = 0.034 and 0.001, respectively).

Research conclusions

LAPPG is beneficial to recovery of anemia and to bile reflux, however, it might be unfavorable in terms of pain and reflux symptoms compared to LADG with Billroth II anastomosis.

Research perspectives

LAPPG has both advantages and disadvantages in reference to long-term functional outcomes. When a physician informs all possible advantages and disadvantages to a patient, and the patient wants to undergo LAPPG, LAPPG could be a treatment option for middle third early gastric cancer. Additional large-scale study is needed to determine the functional superiority of LAPPG and patient-reported QOL.