Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?
AbstractBackgroundPylorus-preserving gastrectomy (PPG) is commonly performed for early gastric cancer (EGC) located in middle third of the stomach. We investigated the surgical, oncological, and functional outcomes of PPG involving the upper third of stomach.MethodsWe included all patients of the period 2013 –2016 who underwent PPG, distal subtotal gastrectomy (DSG), and total gastrectomy (TG) for EGC involving the upper third by carefully defining the localization. Surgical, oncological, and functional outcome analyses included postoperative morbidity, lymph-node metastasis, tumor recurrence, postope rative body weight, body mass index, hemoglobin, total protein, albumin, quantification of intraabdominal fat, and gallstone development.ResultsOverall, 288 cases were analyzed: 145 PPG, 61 DSG, and 82 TG. In the study period, patients potentially underwent PPG for EGC involving the upper third, if enough proximal remnant stomach was found whilst achieving a sufficient proximal margin. PPG resulted in less operation time (p
Prevalence of gallstones is increased after gastrectomy. However, study comparing incidence of gallstone between endoscopic therapy and gastrectomy has been scarce. The aim of this study was to compare incidence of gallstone formation after endoscopic submucosal dissection(ESD) and gastrectomy for treatment of gastric cancer patients during a 5-year follow-up period and to evaluate the risk factors for gallstones formation development after treatment of gastric cancer.
ConclusionsConcomitant PC during gastric surgery for malignancies, although reducing the absolute number of biliary abnormalities, has no significant impact on the natural course of patients.
Rationale: Many studies showed that the risk of gallstone in patients underwent gastrectomy for gastric cancer was increased. As this reason, few studies demonstrated that combined cholecystectomy for asymptomatic gallstone in gastric cancer surgery may be considered. Our goal is to compare the postoperative nutritional status between simultaneous cholecystectomy in gastrectomy and only gastrectomy.
Authors: Seo GH, Lim CS, Chai YJ Abstract Purpose: Gallstone formation is one of the most common problems after gastrectomy. This retrospective cohort study used the South Korean nationwide claims database to evaluate the incidence and risk factors of gallstone after gastrectomy for gastric cancer. Methods: All consecutive patients who underwent gastrectomy for gastric cancer in South Korea in 2008-2010 were identified. Incidence of gallstone formation 5 years after gastrectomy in males and females, in various age groups, and after different types of gastrectomy was determined. Multivariate logistic regression ...
Conclusion: Our analysis indicated that digestive tract reconstruction and vagus nerve resection were strongly and consistently associated with gallstone formation after DG.
ConclusionsPreserving CBVN in LPPG for early gastric cancer is a feasible procedure. However, no clinical benefits of the preservation of the CBVN after LPPG are identified.
ConclusionsProphylactic cholecystectomy may be unnecessary in distal gastrectomy with Billroth I reconstruction.
ConclusionsAlthough few patients required further gallbladder removal after gastrectomy for gastric malignancy, the increased mortality rate for subsequent cholecystectomy was worth noting. The decision to undergo prophylactic cholecystectomy might be individualized based upon patient characteristics and the surgeon ’s discretion.
CONCLUSIONS: The cumulative incidence of gallstones for 5 years after gastrectomy was 15.3%. Male sex, obesity, and exclusion of the duodenum were risk factors for gallstone formation after gastrectomy. Careful surveillance will be required for these patient groups after gastrectomy. PMID: 27433395 [PubMed]
Authors: Oh SY, Lee HJ, Yang HK Abstract 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 ...