Study backs pylorus-preserving gastrectomy in early gastric cancer

Reuters Health Information: Study backs pylorus-preserving gastrectomy in early gastric cancer

Study backs pylorus-preserving gastrectomy in early gastric cancer

Last Updated: 2017-03-30

By David Douglas

NEW YORK (Reuters Health) - In patients with early-stage gastric cancer, laparoscopic pylorus-preserving gastrectomy offers "excellent" long-term prognosis and favorable nutritional status, according to Japanese researchers.

The approach was initially developed for the treatment of benign gastric ulcers, Dr. Naoki Hiki and colleagues at the Japanese Foundation for Cancer Research, in Tokyo, note in the American Journal of Surgery, online March 9. Although its use has subsequently spread to patients with gastric cancer, there have been few reports on long-term prognosis and nutritional outcomes, the team adds.

The researchers retrospectively examined data on 465 patients who underwent the procedure between 2006 and 2012 for surgically resectable (cT1 N0) gastric cancer located in the middle part of the stomach.

Preoperatively, endoscopic marking clips were placed at the cancer-negative tumor border based on biopsy results, and intraoperative gastroscopy was used to verify the tumor location and ensure appropriate resection lines.

In the short term, only 14 patients (3%) had severe complications and there were no in-hospital deaths. Fifteen patients received adjuvant chemotherapy. The median follow-up lasted about five years.

Both five-year overall and relapse-free survival rates were 98%. There were only two confirmed cases of postoperative recurrence, and neither was in the remnant stomach or regional lymph node. One of these patients did not die of cancer until eight years after the operation.

Compared with preoperative findings, serum total protein and albumin levels were significantly higher at six months and at one and two years postoperatively. After a dip at six months postoperatively, hemoglobin levels at one and two years returned to values similar to those seen preoperatively.

Body weight loss, the researchers point out, "is one of the major postgastrectomy syndromes, which can greatly influence the patient’s quality of life."

In the current study, "body weight loss averaged 6.76%, which was acceptable and comparable with previously reported losses," the researchers say. During the same time period at their institution, body weight losses averaged 8.9% after conventional laparoscopic distal gastrectomy for CT1 disease.

Dr. Hiki told Reuters Health by email that in early stage gastric cancer, “laparoscopic pylorus-preserving gastrectomy offers both excellent long-term survival and postoperative nutritional benefits.”

SOURCE: http://bit.ly/2nAvazm

Ann Surg Oncol 2017.

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