Pylorus-preserving gastrectomy in gastric cancer surgery—open and laparoscopic approaches

Abstract

Pylorus-preserving gastrectomy (PPG) has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. In general, PPG procedures have not included suprapyloric lymph node dissection to preserve the pyloric branch of the vagal nerve and the right gastric artery. The aim of this article is to describe procedures for PPG. The technique of laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) is also introduced because PPG is an ideal application for laparoscopic surgery. Between September 2000 and September 2004, we performed 37 cases of conventional PPG and further 73 cases of LAPPG. In these patients, PPG including complete lymph node dissection around the remnant pyloric cuff was performed. For this purpose, it is recommended that the blood flow to the pyloric cuff be maintained by preserving the infrapyloric artery. All the patients showed good postoperative recovery, and no intraoperative or postoperative major complications were observed. No sign of recurrence was found in these 110 patients, and none of them demonstrated dumping syndrome. The procedures of both PPG and LAPPG are technically feasible and have an important role in the surgical management of early gastric cancer in terms of better quality of postoperative life, even with lymphadenectomy including combined suprapyloric lymph node dissection and right gastric artery division.