Background/aims: To evaluate the efficacy and safety of pylorus-preserving gastrectomy (PPG) compared with distal subtotal gastrectomy (DSG) with Billroth I anastomosis for early gastric cancer (EGC).
Methodology: A systematic literature search was performed to identify all eligible studies comparing PPG with DSG. Data on perioperative parameters, postgastrectomy complications and postprandial symptoms, nutritional status, as well as long-term oncological outcomes were extracted from all included studies for metaanalysis.
Results: Sixteen studies (1213 patients) met eligibility criteria. The meta-analysis showed no significant difference in perioperative parameters between PPG and DSG. However, PPG was associated with lower incidence of dumping syndrome, bile reflux, remnant gastritis, cholecystolithiasis and postprandial symptoms, as well as better postoperative nutritional status compared with DSG. Although delayed gastric emptying was more common after PPG, the symptoms related to delayed emptying reduced over time. Long-term oncological outcomes were similar with regard to 5-year survival rate, as well as recurrence and metastasis rate.
Conclusions: Based on current evidences, PPG and DSG have similar surgical and oncological safety, however PPG can provide better postoperative quality of life. Therefore, PPG can be considered as a better surgical option than DSG for carefully selected patients with EGC.