Han Won Ho, Eom Bang Wool, Yoon Hong Man, Ryu Keun Won, Kim Deok Hee, Kim Young-Woo
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.
J Minim Invasive Surg. 2019 Sep 15;22(3):113-118. doi: 10.7602/jmis.2019.22.3.113.
Pylorus-preserving gastrectomy (PPG) is known to have both nutritional and functional advantages over distal gastrectomy for the treatment of early gastric cancer. Although laparoscopic surgery is a popular choice, intracorporeal anastomosis is a newly developed technique that is gaining popularity. This study aimed to determine any differences in the oncological, surgical, and functional outcomes of intracorporeal and extracorporeal anastomosis after PPG.
A retrospective analysis was performed on 90 patients for cT1N0 gastric cancer who underwent laparoscopic pylorus preserving gastrectomy from January 2015 to June 2017 at the OOO, Korea; 38 patients underwent intracorporeal (TLPPG) and 52 underwent extracorporeal (LAPPG) anastomosis. The postoperative oncological, surgical, and functional outcomes were compared between the two groups. In order to compare the outcomes in obese patients, the postoperative and functional outcomes in patients with a BMI of ≥25, and in those with abdominal wall thickness measuring ≥28 mm, were evaluated.
The TLPPG group showed a significantly reduced wound size (4 cm (34) vs 5 cm (56), <0.001) and had fewer wound complaints than the LAPPG group (0.0% vs 15.4%, =0.01). Postoperative complications were not significantly different between the two groups. In the BMI ≥25 subgroup, the first flatus time after operation was shorter in the TLPPG group (2.9±0.5 vs 3.5±0.8 days, =0.04).
The study demonstrates that both TLPPG and LAPPG are safe and feasible, and that there is a potential benefit for obese patients.
已知保留幽门的胃切除术（PPG）在治疗早期胃癌方面比远端胃切除术具有营养和功能优势。尽管腹腔镜手术是一种常用选择，但体内吻合术是一种新兴技术且越来越受欢迎。本研究旨在确定PPG术后体内吻合术和体外吻合术在肿瘤学、手术和功能结局方面的差异。
对2015年1月至2017年6月在韩国OOO接受腹腔镜保留幽门胃切除术的90例cT1N0期胃癌患者进行回顾性分析；38例患者接受体内（TLPPG）吻合，52例接受体外（LAPPG）吻合。比较两组术后的肿瘤学、手术和功能结局。为了比较肥胖患者的结局，评估了体重指数（BMI）≥25的患者以及腹壁厚度≥28 mm的患者的术后和功能结局。
TLPPG组的伤口大小明显减小（4 cm（34）vs 5 cm（56），<0.001），且伤口相关主诉少于LAPPG组（0.0% vs 15.4%，=0.01）。两组术后并发症无显著差异。在BMI≥25的亚组中，TLPPG组术后首次排气时间较短（2.9±0.5天vs 3.5±0.8天，=0.04）。
该研究表明TLPPG和LAPPG都是安全可行的，且对肥胖患者可能有益。
