Laparoscopic pylorus preservation gastrectomy to investigate the effectiveness and safety of early gastric cancer treatment
Dec 06, 2024
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A KLASS-04 research team consisting of 16 researchers from nine institutions in Korea, including professors Lee Hyuk-joon, Yang Han-kwang, Park Do-joong, and Gong Sung-ho at Seoul National University Hospital, former professors Kim Hyung-ho and professors Seo Yoon-seok and Ahn Sang-hoon, announced on the 6th that they have followed the prognosis of laparoscopic pylorus preservation gastrectomy and laparoscopic distal gastrectomy for three years on 256 patients with early gastric cancer in the middle.
With the recent activation of gastroscopy, 70% of gastric cancers are detected early, and 9 out of 10 such early gastric cancer patients can be cured by surgery. Therefore, the importance of conservative surgery to reduce side effects by minimizing the resection site to maintain gastrointestinal function after surgery is growing.
The existing standard laparoscopic surgical method, 'Distal gastrectomy (LDG)', is a surgical method that connects the lower and two-thirds of the stomach, including the pylorus (the site of the connection between the stomach and the duodenum), and then connects the remaining stomach and small intestine. There is a problem that food that enters the stomach directly goes down to the small intestine, causing diarrhea or reflux of bile. In order to reduce these side effects and improve the quality of life of patients by maintaining the stomach function as much as possible, 'pylori preservation gastrectomy (LPPG)' was designed to preserve the lower and pylorus of the stomach and resect only about half of the middle part of the stomach. However, so far, there have been no multicenter randomized studies in the world that objectively compare the two surgical methods.
Accordingly, the research team divided 256 patients with early gastric cancer in the middle of the stomach into ▲ pylorus preserved gastrectomy (pylorus preserved group) ▲ distal gastrectomy (distal resection group) group, and followed up the results of the surgery. The primary evaluation index was dumping syndrome at year 1 postoperative, and the secondary evaluation index was complication, nutritional status, recurrence rate, and quality of life followed at 3 years postoperative.
As a result of the analysis, there was no significant difference in the incidence of dumping syndrome, 15.8% and 13.2% in the pylorus conservation group and the distal resection group, respectively.
Dumping syndrome refers to systemic symptoms such as abdominal pain, diarrhea, hypoglycemia, and sweating caused by food going undigested to the small intestine.
The nutritional status was found to be well maintained in the pylorus-preserving group compared to the distal resection group. Hemoglobin, protein, and albumin levels evaluated by blood tests 3 years after surgery were all high in the pylori conservation group.
In addition, the incidence of cholelithiasis (2.3% vs. 8.6%) and the incidence of reflux gastritis (6.3% vs. 17.8%) in the pylorus-preserving group and the distal resection group were excellent. In other words, pylorus-preserving gastrectomy showed less occurrence of 'cholelithiasis and reflux gastritis'. On the other hand, the incidence of reflux esophagitis (17.8% vs. 6.3%) and gastric emptying (16.3% vs. 3.9%), and the incidence of gastric emptying into the duodenum was higher in the pylorus-preserving resection group than in the distal resection group. However, there was no significant difference in overall complication incidence and quality of life in the two groups.
Additionally, there were no significant differences in the overall and disease-free survival rates of the two groups. The overall survival rate after 3 years of surgery was 99% and 100% in the pylorus-preserving and distal resection groups, respectively, and the disease-free survival rate after 3 years was 99% in both groups.
In other words, the research team confirmed that the pylorus-preserving gastrectomy group had better nutritional indicators after surgery than the standard treatment, distal gastrectomy group, and there was no significant difference in complication incidence and survival rate.
Professor Lee Hyuk-jun (Gastrointestinal Surgery), the first author, said, `It is meaningful that this study can objectively confirm the clinical effect and safety of pylorus-preserving gastrectomy, a relatively latest surgical technique, in the treatment of early gastric cancer patients in the middle of the stomach." We will continue to make efforts to develop gastric cancer surgery methods that improve the quality of life after surgery.'
Meanwhile, the study, which was conducted for the fourth time by the Korean Society of Laparoscopic Gastrointestinal Tract, was published in the recent issue of the "Annals of Surgery", the most prestigious journal in the field of surgery.
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This article was translated by Naver AI translator.
