Laparoscopy-Assisted Pylorus-Preserving Gastrectomy for Treating Early Gastric Cancer

Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with lymphadenectomy has been used for treating early gastric cancer located in the middle-third of the stomach. However, firm evidence supporting its safety and usefulness is scant. This study examined 24 and 10 gastric adenocarcinoma patients who had undergone conventional pylorus-preserving gastrectomy (CPPG) and LAPPG, respectively, at our institution. Operation time for LAPPG (362.8 ± 49.6 min) was significantly longer than that for CPPG (221.9 ± 50.0 min; P = 0.04). Estimated blood loss with LAPPG (127.5 ± 91.2 mL) was not significantly different from that with CPPG (167.9 ± 149.9 mL; P = 0.44). Total number of resected lymph nodes was 26.3 ± 9.5 and 21.3 ± 10.8 with LAPPG and CPPG, respectively, with no statistically significant difference. C-reactive protein in serum on postoperative day 1 was significantly lower in the LAPPG than in the CPPG group (5.3 ± 1.7 mg/dL versus 7.8 ± 3.6 mg/dL; P = 0.049). The requirement for analgesia after surgery was more frequent in the CPPG than in the LAPPG group (3.7 ± 2.0 versus 2.2 ± 1.7; P = 0.04). Time to first flatus was shorter in the LAPPG than in the CPPG group (1.9 ± 0.9 days versus 3.1 ± 0.9 days; P = 0.0006). Postoperative hospital stay was significantly shorter in the LAPPG than in the CPPG group (12.0 ± 4.0 days versus 23.0 ± 10.7days; P = 0.0036). With regard to postoperative complications, stasis was observed more frequently in the CPPG (33.3%) than in the LAPPG (10%) group. In conclusion, patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by CPPG.