Center for Gastric Cancer, National Cancer Center, Goyang 10408, South Korea.
Biostatistics Collaboration Team, Research Core, Research institute, National Cancer Center, Goyang 10408, South Korea.
World J Gastroenterol. 2019 Sep 28;25(36):5494-5504. doi: 10.3748/wjg.v25.i36.5494.
Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was known to have benefits of function-preserving surgery compared to laparoscopy-assisted distal gastrectomy (LADG). However, in clinical settings, delayed gastric emptying and esophageal reflux following LAPPG can be serious issues, making surgeons reluctant to perform LAPPG. It is unclear that LAPPG had better long-term functional outcomes and quality of life compared to LADG.
To evaluate the long-term functional outcomes and patient-reported quality of life of LAPPG compared to those of LADG.
We reviewed the clinicopathological data of 195 patients who underwent LADG with Billroth II anastomosis and 101 patients who underwent LAPPG for cT1N0 gastric cancer in the middle third of the stomach between 2012 and 2015. Postoperative complications, nutritional parameters, and survey results of the European Organization for Research and Treatment of Cancer Questionnaire C30 and STO22 questionnaire were compared between the two groups.
The serum hemoglobin level was significantly higher in the LAPPG group than in the LADG group ( < 0.001). In the endoscopic findings, incidence of bile reflux was lower ( < 0.001); however, the incidence of residual food was higher in the LAPPG group than in the LADG group ( < 0.001). Regarding the quality of life score, the LAPPG group had a better physical functioning score (86.7 90.0, = 0.032) but also greater pain and reflux when compared to the LADG group [8.3 16.7 in pain, 11.1 (interquartile range, 0, 22.2) 11.1 (interquartile range, 11.1, 33.3) in reflux, = 0.034 and 0.001, respectively].
LAPPG is beneficial to recovery of anemia and to bile reflux, however, it might be unfavorable in terms of pain and reflux symptoms compared to LADG with Billroth II anastomosis.
与腹腔镜辅助远端胃切除术（LADG）相比，腹腔镜辅助保留幽门胃切除术（LAPPG）具有保留功能的优势。然而，在临床实践中，LAPPG 后胃排空延迟和食管反流可能是严重的问题，这使得外科医生不愿意进行 LAPPG。目前尚不清楚 LAPPG 与 LADG 相比是否具有更好的长期功能结局和生活质量。
评估 LAPPG 与 LADG 相比的长期功能结局和患者报告的生活质量。
我们回顾了 2012 年至 2015 年间接受 Billroth II 吻合术的 LADG 治疗的 195 例 cT1N0 胃中部胃癌患者和接受 LAPPG 治疗的 101 例患者的临床病理资料。比较两组患者术后并发症、营养参数以及欧洲癌症研究与治疗组织问卷 C30 和 STO22 问卷的调查结果。
LAPPG 组的血清血红蛋白水平明显高于 LADG 组（<0.001）。在内镜检查结果中，胆汁反流的发生率较低（<0.001）；然而，LAPPG 组的残食发生率高于 LADG 组（<0.001）。在生活质量评分方面，LAPPG 组的身体功能评分较好（86.7±90.0， =0.032），但与 LADG 组相比，疼痛和反流更为严重[疼痛评分分别为 8.3±16.7 和 11.1（四分位距，0，22.2）和 11.1（四分位距，11.1，33.3）， =0.034 和 0.001]。
与 Billroth II 吻合的 LADG 相比，LAPPG 有利于贫血的恢复和胆汁反流，但在疼痛和反流症状方面可能不利。
