Relationships between Length of the Antral Cuff and Postgastrectomy Disorders and Gastric Empting Function in Patients after Pylorus-Preserving Gastrectomy for Early Gastric Cancer

Ryouichi Tomita,Shigeru Fujisaki,Kenichi Sakurai

doi:10.4236/jct.2017.810076

Ryouichi Tomita, Shigeru Fujisaki + Show 1 more

Open Access

https://doi.org/10.4236/jct.2017.810076

Copy DOI

Abstract

Objectives: To clarify the optimal length of the antral cuff (LAC) in patients after pylorus-preserving gastrectomy (PPG), we investigated relationships between LAC and postgastrectomy disorder (PGD) such as postprandial abdominal fullness (PAF), and between LAC and gastric empting function (GEF) in PPG patients. Background: The main cause of PGD in PPG patients has been considered to be LAC. Relationships between LAC and PGD and GEF in PPG patients are still unknown. Methods: Of 50 patients who underwent PPG in our hospital from January 2001 to December 2015 were divided into 2 groups [Group A, short LAC of 1.5 to 2.5 cm (n = 24); Group B, long LAC of 2.6 to 3.5 cm (n = 26)]. The relationships among LAC, PGD, and GEF were retrospectively studied. Results: LAC was clearly shorter in group A than group B (P < 0.01). PAF, appetite and food consumption per meal were clearly more favorable in group B than in group A (P < 0.01, respectively). Symptomatic reflux esophagitis (RE), early dumping syndrome, decreased percent body weight for pre-illness, endoscopic RE and endoscopic gastritis in the remnant stomach were more frequent in group A than group B. Gastric stasis in the remnant stomach was clearly more frequent in group A than group B (P < 0.01). GEF with the solid diet in group A was clearly more delayed than in group B (P < 0.01). Conclusions: Patients with a short LAC showed worse postoperative QOL and delayed GEF with the solid diet compared with a long LAC.

Highlights

In clinicopathological analyses, pylorus-preserving gastrectomy (PPG) are associated with clearly lower incidences of early dumping syndrome (EDS), gastritis in the remnant stomach and reflux esophagitis (RE) as well as a significant decrease in postoperative malnutrition due to loss of appetite and postoperative body weight loss [1] [2] [3] [4]
Aim of the study We studied the correlations between length of the antral cuff (LAC) and postgastrectomy disorder (PGD) including postprandial abdominal fullness (PAF) and gastric stasis in the remnant stomach (GSRS), and between LAC and gastric empting function (GEF) of the residual stomach in patients who underwent PPG for early gastric cancer
Symptomatic RE, EDS and decreased percent body weight compared with pre-illness were more frequent in group A than in group B

Summary

Introduction

PPG are associated with clearly lower incidences of early dumping syndrome (EDS), gastritis in the remnant stomach and reflux esophagitis (RE) as well as a significant decrease in postoperative malnutrition due to loss of appetite and postoperative body weight loss [1] [2] [3] [4]. Patients after PPG have been reported to have a better postoperative quality of life (QOL) [1] [2] [3] [4]. The most common demerit in patients after PPG is postprandial abdominal fullness (PAF: early satiety, postprandial fullness and diet limitation are frequent symptoms) due to gastric stasis in the remnant stomach (GSRS) [1] [2] [3] [5] [6] [7]. Food consumption per meal becomes insufficient and leads to a marked deterioration of the postoperative QOL, which is one of the major problems in patients after PPG. It is considered that PAF may be caused by GSRS due to delay of the gastric emptying function (GEF)

Objectives

Methods

Discussion

Conclusion