Terayama Masayoshi, Ohashi Manabu, Makuuchi Rie, Hayami Masaru, Ida Satoshi, Kumagai Koshi, Sano Takeshi, Nunobe Souya
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
Gastric Cancer. 2023 Jan;26(1):145-154. doi: 10.1007/s10120-022-01345-2. Epub 2022 Oct 7.
In older patients with cT1N0M0 gastric cancer in the middle third of the stomach, LPPG has advantages over LDGB1 in maintaining skeletal muscle mass.
Laparoscopic pylorus-preserving gastrectomy (LPPG) for early gastric cancer in the middle third of the stomach is expected to be an alternative procedure to laparoscopic distal gastrectomy (LDG). However, whether LPPG is safe and more useful than LDG in older patients is unclear because of their comorbidities and organ dysfunctions.
We retrospectively analyzed the data of consecutive patients aged 75 or over who underwent LDG with Billroth I reconstruction (LDGB1) or LPPG for cT1N0M0 gastric cancer in the middle third of the stomach between 2005 and 2019. After propensity score matching was used to improve the comparability between the LDGB1 and LPPG groups, we compared surgical and postoperative nutritional outcomes, including the postoperative trends of bodyweight (%BW) and skeletal muscle index (%SMI).
A total of 132 patients who underwent LDGB1 (n = 88) and LPPG (n = 44) were collected for this study. No significant difference in postoperative complications was observed. The total protein levels after LPPG were significantly higher than those after LDGB1 for 4 postoperative years. Both %BW and %SMI after LPPG were significantly maintained compared with those after LDGB1 during the first year after surgery. For the subsequent years, %BW after LPPG became similar to that after LDGB1, while %SMI after LPPG was significantly larger than LDGB1 continuously.
LPPG has a great advantage in maintaining the postoperative skeletal muscle mass as well as the nutritional parameters of older patients. LPPG is expected to be an alternative to LDG in older patients.
对于胃中三分之一处患有cT1N0M0胃癌的老年患者，腹腔镜保留幽门胃切除术（LPPG）在维持骨骼肌质量方面优于腹腔镜毕Ⅰ式远端胃切除术（LDGB1）。
对于胃中三分之一处的早期胃癌，腹腔镜保留幽门胃切除术（LPPG）有望成为腹腔镜远端胃切除术（LDG）的替代手术。然而，由于老年患者存在合并症和器官功能障碍，LPPG在老年患者中是否安全且比LDG更有用尚不清楚。
我们回顾性分析了2005年至2019年间连续接受LDG毕Ⅰ式重建术（LDGB1）或LPPG治疗胃中三分之一处cT1N0M0胃癌的75岁及以上患者的数据。在使用倾向评分匹配以提高LDGB1组和LPPG组之间的可比性后，我们比较了手术和术后营养结局，包括体重（%BW）和骨骼肌指数（%SMI）的术后变化趋势。
本研究共收集了132例接受LDGB1（n = 88）和LPPG（n = 44）的患者。术后并发症无显著差异。术后4年，LPPG后的总蛋白水平显著高于LDGB1后的总蛋白水平。与LDGB1术后相比，LPPG术后第一年的%BW和%SMI均得到显著维持。在随后几年中，LPPG术后的%BW与LDGB1术后相似，而LPPG术后的%SMI持续显著大于LDGB1术后。
LPPG在维持老年患者术后骨骼肌质量以及营养参数方面具有很大优势。LPPG有望成为老年患者LDG的替代手术。
