Oh, Seung-Young
(Department of Surgery, Seoul National University College of Medicine)
,
Lee, Hyuk-Joon
(Department of Surgery, Seoul National University College of Medicine)
,
Yang, Han-Kwang
(Department of Surgery, Seoul National University College of Medicine)
Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 g...
Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG.
Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
Although a few studies have evaluated the optimal surgical procedures to treat EGC of the middle-third of the stomach, comparing LAPPG and LADG, most studies on PPG have been performed at a single center with a limited number of patients and in a retrospective manner. For the application of LAPPG in the clinical setting, it is essential to first perform a comparative analysis of the short- and long-term outcomes from a large volume of prospective randomized data. In order to determine whether the postoperative QOL and nutritional status are better, and if survival is comparable after LAPPG, the KLASS group has initiated a multicenter RCT (KLASS-04 study) to compare LAPPG and LADG for EGC of the middle-third of the stomach (NCT No.
대상 데이터
A total of 256 patients, diagnosed with a cT1N0M0 primary gastric adenocarcinoma located in the middle-third of the stomach by endoscopic ultrasonography or CT, will be enrolled (128 patients in each group) (Table 2). The primary endpoint is the incidence of dumping syndrome, assessed using the Sigstad score (≥7) at 1 year after surgery.
성능/효과
1).30In both studies, most of the patients with LN metastasis in station 5 were finally confirmed as having at least T2 cancer after surgeries, whereas the metastasis rates to LN station 5 were very low for T1 cancer. Furthermore, Hiki et al.
6%).12In both studies, the most common complication was associated with postoperative impairment in pyloric function; gastric stasis was present in 6.2% in the former study and DGE in 7.8% in the latter.
17 in 2002. In that study, the authors found that the incidence of DGE was 35.0% (7/20) in patients with an antral cuff length of 1.5 cm and only 10.0% (1/10) in patients with an antral cuff length of 2.5 cm, at 1 year after surgery. Nunobe et al.
참고문헌 (53)
1 Kim YG Kong SH Oh SY Lee KG Suh YS Yang JY Effects of screening on gastric cancer management: comparative analysis of the results in 2006 and in 2011 J Gastric Cancer 2014 14 129 134 25061541
2 Kim YW Baik YH Yun YH Nam BH Kim DH Choi IJ Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial Ann Surg 2008 248 721 727 18948798
3 Ahn HS Lee HJ Yoo MW Jeong SH Park DJ Kim HH Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period Br J Surg 2011 98 255 260 21082693
4 Adachi Y Suematsu T Shiraishi N Katsuta T Morimoto A Kitano S Quality of life after laparoscopy-assisted Billroth I gastrectomy Ann Surg 1999 229 49 54 9923799
6 Kim HH Han SU Kim MC Hyung WJ Kim W Lee HJ Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study J Clin Oncol 2014 32 627 633 24470012
7 Kim W Kim HH Han SU Kim MC Hyung WJ Ryu SW Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01) Ann Surg 2016 263 28 35 26352529
8 Saito T Kurokawa Y Takiguchi S Mori M Doki Y Current status of function-preserving surgery for gastric cancer World J Gastroenterol 2014 20 17297 17304 25516640
9 Maki T Shiratori T Hatafuku T Sugawara K Pylorus-preserving gastrectomy as an improved operation for gastric ulcer Surgery 1967 61 838 845 5338114
10 Nunobe S Sasako M Saka M Fukagawa T Katai H Sano T Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer Gastric Cancer 2007 10 167 172 17922094
11 Park DJ Lee HJ Jung HC Kim WH Lee KU Yang HK Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis World J Surg 2008 32 1029 1036 18256877
12 Suh YS Han DS Kong SH Kwon S Shin CI Kim WH Laparoscopy-assisted pylorus-preserving gastrectomy is better than laparoscopy-assisted distal gastrectomy for middle-third early gastric cancer Ann Surg 2014 259 485 493 23652333
14 Kodama M Koyama K Chida T Arakawa A Tur G Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer World J Surg 1995 19 456 460 discussion 61 7639006
15 Imada T Rino Y Takahashi M Suzuki M Tanaka J Shiozawa M Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy Surgery 1998 123 165 170 9481402
16 Zhang D Shimoyama S Kaminishi M Feasibility of pylorus-preserving gastrectomy with a wider scope of lymphadenectomy Arch Surg 1998 133 993 997 9749854
17 Nakane Y Michiura T Inoue K Sato M Nakai K Yamamichi K Length of the antral segment in pylorus-preserving gastrectomy Br J Surg 2002 89 220 224 11856138
18 Nunobe S Hiki N Fukunaga T Tokunaga M Ohyama S Seto Y Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis World J Surg 2007 31 2335 2340 17952497
19 Hotta T Taniguchi K Kobayashi Y Johata K Sahara M Naka T Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer Surg Today 2001 31 774 779 11686554
20 Lee SW Bouras G Nomura E Yoshinaka R Tokuhara T Nitta T Intracorporeal stapled anastomosis following laparoscopic segmental gastrectomy for gastric cancer: technical report and surgical outcomes Surg Endosc 2010 24 1774 1780 20039069
21 Morita S Katai H Saka M Fukagawa T Sano T Sasako M Outcome of pylorus-preserving gastrectomy for early gastric cancer Br J Surg 2008 95 1131 1135 18690631
22 Nagano H Ohyama S Sakamoto Y Ohta K Yamaguchi T Muto T The endoscopic evaluation of gastritis, gastric remnant residue, and the incidence of secondary cancer after pylorus-preserving and transverse gastrectomies Gastric Cancer 2004 7 54 59 15052441
23 Nishikawa K Kawahara H Yumiba T Nishida T Inoue Y Ito T Functional characteristics of the pylorus in patients undergoing pylorus: preserving gastrectomy for early gastric cancer Surgery 2002 131 613 624 12075173
24 Ohya T Ohwada S Iesato H Takeyoshi I Kawashima Y Ogawa T Jejunal pouch interposition after pylorus-preserving gastrectomy J Surg Res 1999 86 177 182 10534421
25 Tomikawa M Korenaga D Akahoshi T Kohshi K Sugimachi K Nagao Y Quality of life after laparoscopy-assisted pylorus-preserving gastrectomy: an evaluation using a questionnaire mailed to the patients Surg Today 2012 42 625 632 22527179
26 Tomita R Fujisaki S Tanjoh K Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer World J Surg 2003 27 725 733 12734683
27 Urushihara T Sumimoto K Shimokado K Kuroda Y Gastric motility after laparoscopically assisted distal gastrectomy, with or without preservation of the pylorus, for early gastric cancer, as assessed by digital dynamic x-ray imaging Surg Endosc 2004 18 964 968 15095077
28 Morita S Sasako M Saka M Fukagawa T Sano T Katai H Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy Gastric Cancer 2010 13 109 116 20602198
29 Shibata C Saijo F Kakyo M Kinouchi M Tanaka N Sasaki I Current status of pylorus-preserving gastrectomy for the treatment of gastric cancer: a questionnaire survey and review of literatures World J Surg 2012 36 858 863 22350486
30 Kong SH Kim JW Lee HJ Kim WH Lee KU Yang HK The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy Ann Surg Oncol 2009 16 3252 3258 19639365
31 Haruta S Shinohara H Ueno M Udagawa H Sakai Y Uyama I Anatomical considerations of the infrapyloric artery and its associated lymph nodes during laparoscopic gastric cancer surgery Gastric Cancer 2015 18 876 880 25228163
32 Sawai K Takahashi T Fujioka T Minato H Taniguchi H Yamaguchi T Pylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variations of the infrapyloric artery Am J Surg 1995 170 285 288 7661298
33 Hiki N Shimoyama S Yamaguchi H Kubota K Kaminishi M Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation J Am Coll Surg 2006 203 162 169 16864028
34 Tanaka N Katai H Saka M Morita S Fukagawa T Laparoscopy-assisted pylorus-preserving gastrectomy: a matched case-control study Surg Endosc 2011 25 114 118 20526619
35 Hiki N Kaminishi M Pylorus-preserving gastrectomy in gastric cancer surgery: open and laparoscopic approaches Langenbecks Arch Surg 2005 390 442 447 16096761
36 Kumagai K Hiki N Nunobe S Sekikawa S Chiba T Kiyokawa T Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes Gastric Cancer 2015 18 183 187 24481853
37 Shibata C Shiiba KI Funayama Y Ishii S Fukushima K Mizoi T Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial World J Surg 2004 28 857 861 15593456
38 Jiang X Hiki N Nunobe S Fukunaga T Kumagai K Nohara K Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer Ann Surg 2011 253 928 933 21358534
39 Dindo D Demartines N Clavien PA Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey Ann Surg 2004 240 205 213 15273542
40 Sasako M McCulloch P Kinoshita T Maruyama K New method to evaluate the therapeutic value of lymph node dissection for gastric cancer Br J Surg 1995 82 346 351 7796005
41 Kodera Y Yamamura Y Kanemitsu Y Shimizu Y Hirai T Yasui K Lymph node metastasis in cancer of the middle-third stomach: criteria for treatment with a pylorus-preserving gastrectomy Surg Today 2001 31 196 203 11318120
42 Hiki N Nunobe S Kubota T Jiang X Function-preserving gastrectomy for early gastric cancer Ann Surg Oncol 2013 20 2683 2692 23504120
43 Yoo MW Park DJ Ahn HS Jeong SH Lee HJ Kim WH Evaluation of the adequacy of lymph node dissection in pylorus-preserving gastrectomy for early gastric cancer using the maruyama index World J Surg 2010 34 291 295 20012611
44 Hiki N Sano T Fukunaga T Ohyama S Tokunaga M Yamaguchi T Survival benefit of pylorus-preserving gastrectomy in early gastric cancer J Am Coll Surg 2009 209 297 301 19717032
45 Xiao XM Gaol C Yin W Yu WH Qi F Liu T Pylorus-preserving versus distal subtotal gastrectomy for surgical treatment of early gastric cancer: a meta-analysis Hepatogastroenterology 2014 61 870 879 26176089
46 Isozaki H Okajima K Momura E Ichinona T Fujii K Izumi N Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer Br J Surg 1996 83 266 269 8689185
47 Mine S Sano T Tsutsumi K Murakami Y Ehara K Saka M Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer J Am Coll Surg 2010 211 628 636 20829078
48 Fujita J Takahashi M Urushihara T Tanabe K Kodera Y Yumiba T Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study Gastric Cancer 2016 19 302 311 25637175
49 Song P Lu M Pu F Zhang D Wang B Zhao Q Meta-analysis of pylorus-preserving gastrectomy for middle-third early gastric cancer J Laparoendosc Adv Surg Tech A 2014 24 718 727 25243417
50 Fujita T Outcome of pylorus-preserving gastrectomy for early gastric cancer (Br J Surg 2008;95:1131-1135) Br J Surg 2008 95 1429 author reply 1429-1430 18844261
51 Bae JS Kim SH Shin CI Joo I Yoon JH Lee HJ Efficacy of gastric balloon dilatation and/or retrievable stent insertion for pyloric spasms after pylorus-preserving gastrectomy: retrospective analysis PLoS One 2015 10 e0144470 26657405
52 Han DS Suh YS Ahn HS Kong SH Lee HJ Kim WH Comparison of surgical outcomes of robot-assisted and laparoscopy-assisted pylorus-preserving gastrectomy for gastric cancer: a propensity score matching analysis Ann Surg Oncol 2015 22 2323 2328 25361887
53 Kim HI Han SU Yang HK Kim YW Lee HJ Ryu KW Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma Ann Surg 2016 263 103 109 26020107
※ AI-Helper는 부적절한 답변을 할 수 있습니다.