Short-term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer: Comparison Between Extracorporeal and Intracorporeal Gastrogastrostomy

Khalid Alzahrani; Ji-Hyeon Park; Hyuk-Joon Lee; Shin-Hoo Park; Jong-Ho Choi; Chaojie Wang; Fadhel Alzahrani; Yun-Suhk Suh; Seong-Ho Kong; Do Joong Park; Han-Kwang Yang

doi:10.5230/jgc.2022.22.e16

Short-term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer: Comparison Between Extracorporeal and Intracorporeal Gastrogastrostomy

J Gastric Cancer. 2022 Apr;22(2):135-144. doi: 10.5230/jgc.2022.22.e16.

Authors

Khalid Alzahrani^#^{1

2}, Ji-Hyeon Park^#^{1

3}, Hyuk-Joon Lee^{1

4

5}, Shin-Hoo Park^{1

6}, Jong-Ho Choi^{1

7}, Chaojie Wang^{1

8}, Fadhel Alzahrani^{1

9}, Yun-Suhk Suh^{4

10}, Seong-Ho Kong^{1

4}, Do Joong Park^{1

4

11}, Han-Kwang Yang^{1

4

11}

Affiliations

¹ Department of Surgery, Seoul National University Hospital, Seoul, Korea.
² Department of Surgery, Taif University, College of Medicine, Taif, Saudi Arabia.
³ Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea.
⁴ Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
⁵ Cancer Research Institute, Seoul National University, Seoul, Korea. appe98@snu.ac.kr.
⁶ Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
⁷ Department of Surgery, Eulji University, Seoul, Korea.
⁸ Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ Department of Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
¹⁰ Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
¹¹ Cancer Research Institute, Seoul National University, Seoul, Korea.

^# Contributed equally.

Abstract

Purpose: This study aimed to compare the surgical and oncological outcomes between totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with intracorporeal anastomosis and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with extracorporeal anastomosis.

Materials and methods: A retrospective analysis was performed in 258 patients with cT1N0 gastric cancer who underwent laparoscopic pylorus-preserving gastrectomy using two different anastomosis methods: TLPPG with intracorporeal anastomosis (n=88) and LAPPG with extracorporeal anastomosis (n=170). The following variables were compared between the two groups to assess the postoperative surgical and oncological outcomes: proximal and distal margins, number of resected lymph nodes (LNs) in total and in LN station 6, operation time, postoperative hospital stay, and postoperative morbidity including delayed gastric emptying (DGE).

Results: The average length of the proximal margin was similar between the TLPPG and LAPPG groups (2.35 vs. 2.73 cm, P=0.070). Although the distal margin was significantly shorter in the TLPPG group than in the LAPPG group (3.15 vs. 4.08 cm, P=0.001), no proximal or distal resection margin-positive cases were reported in either group. The average number of resected LN was similar in both groups (36.0 vs. 33.98, P=0.229; LN station 6, 5.72 vs. 5.33, P=0.399). The operation time was shorter in the TLPPG group than in the LAPPG (200.17 vs. 220.80 minutes, P=0.001). No significant differences were observed between the two groups in terms of postoperative hospital stay (9.38 vs. 10.10 days, P=0.426) and surgical complication rate (19.3% vs. 22.9%), including DGE (8.0% vs. 11.8%, P=0.343).

Conclusions: The oncological safety and postoperative complications of TLPPG with intracorporeal anastomosis are similar to those of LAPPG with extracorporeal anastomosis.

Keywords: Early gastric cancer; Extracorporeal anastomosis; Function-preserving gastrectomy; Intracorporeal anastomosis.