Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis.

摘要

BACKGROUND: Pylorus-preserving gastrectomy (PPG) was originally a treatment option in gastric ulcer surgery and is now being performed as a limited surgery in some early gastric cancer cases. This study was designed to evaluate the postoperative functional characteristics of PPG versus conventional distal gastrectomy with Billroth I anastomosis (BI). METHODS: Patients who underwent PPG (study group) between November 1999 and April 2003 were enrolled and BI patients (control group) were matched for number, gender, age, weight, height, stage, and follow-up period. We evaluated postprandial symptoms and nutritional status. Gastric emptying studies with a 99mTc gamma camera, follow-up endoscopies with random biopsies of remnant gastric mucosa to evaluate bile reflux gastritis, and ultrasonography to detect gallbladder stones were performed. Recurrence and survival also were investigated. RESULTS: Twenty-two PPG patients (study group) and 17 BI patients (control group) were enrolled. Overall modified Visick scores of postprandial symptoms were lower in PPG patients than in BI patients (0.9 +/- 0.7 vs. 2.3 +/- 1.4; p = 0.018). Gastric emptying was delayed in PPG patients versus BI patients for solids (p < 0.05). Moderate gastritis, bile reflux, and gallbladder stone were observed only in BI patients. Remnant stomach pathologic findings corresponding to bile reflux gastritis in the two groups were similar, except for Helicobacter pylori colonization. No recurrence occurred in either group (mean follow-up period = 41 +/- 9.5 months). CONCLUSIONS: PPG patients had fewer subjective postprandial symptoms than BI patients. The present study also suggests that PPG has advantages over BI in terms of the avoidance of bile reflux and gallbladder stones.