Postoperative evaluation of function-preserving gastrectomy for early gastric cancer

Abstract

Background/aims: We evaluated the efficacy of the following three surgical options in gastrectomy for early gastric cancer; 1) reduction of the extent of gastrectomy, 2) preservation of the vagal nerve, and 3) preservation of the pylorus.

Methodology: The postoperative physical conditions of patients who had undergone 6 kinds of operating methods incorporating elements 1), 2) and 3) were compared. The efficacy of elements 1) and 3) was evaluated by comparison among a 2/3 proximal gastrectomy group (2/3-PG group, n = 5), 4/5 proximal gastrectomy group (4/5-PG group, n = 7), and total gastrectomy group (TG group, n = 12). The efficacy of elements 1), 2) and 3) was also evaluated by comparison among a pylorus-preserving gastrectomy (PPG) group with preservation of the vagal nerve (PPGV group, n = 15), 2/3 distal gastrectomy group with preservation of the vagal nerve (2/3-DGV group, n = 12), and 4/5 distal gastrectomy group without preservation of the vagal nerve (4/5-DG group, n = 15).

Results: Body weight loss and the incidence of abdominal symptoms and anemia in the 2/3-PG group, PPGV or 2/3-DGV group were less frequent than in the TG group or 4/5-DG group. The increases in acetaminophen concentration in the 2/3-PG group, PPGV or 2/3-DGV groups, and the changes in blood sugar and insulin levels in the 2/3-PG or PPGV group were modest, while hypergastrinemia in the 2/3-PG group was remarkable. The insulinogenic index was high in the 2/3-DGV group, and the plasma cholecystokinin changes and contraction pattern of the gallbladder resembled their preoperative pattern in the PPGV and 2/3-DGV groups. These results indicated that the patients in the 2/3-PG group owed their benefits to elements 1) and 3), the 2/3-DGV group to elements 1) and 2), and the PPGV group to elements 1), 2) and 3).

Conclusions: Three surgical options in gastrectomy procedures for early gastric cancer, 1) reduction of the extent of gastrectomy, 2) preservation of the vagal nerve, and 3) preservation of the pylorus, were individually confirmed to have benefits for better postoperative quality of life.