Long-Term Clinical Outcome and Survival after Pylorus-Preserving Gastrectomy

Pylorus-preserving gastrectomy (PPG) was introduced as a function preserving and minimally-invasive surgery for early gastric cancer (ECG). We investigated the long-term clinical and oncological outcomes of the procedure.A total of 433 patients who underwent PPG between 1993 and 2009 were assessed retrospectively.The accuracy of the preoperative diagnosis of EGC was 93.1%. The incidence of lymph node metastasis was 3.7%. The median follow-up period was 77 (9-201) months. The overall 5-year survival rate was 96.6%. Three patients with advanced cancer developed recurrence and died. Thirteen patients developed a second primary gastric cancer in the remnant stomach. Four patients were treated by endoscopic resection, and nine underwent gastrectomy all with curative intent. The incidence of regurgitation and gastric-fullness at 5 years after PPG were 6.1% and 1.5%. Endoscopic findings of residual food, gastritis, bile reflex and reflux esophagitis were 19.1%, 11.0%, 3.0%, 10.0%, respectively. The mean relative body weight recovered up to 94.0% of that prior to surgery after 1 year and maintained.PPG is a safe operative procedure for patients with EGC. It is important to improve the accuracy of preoperative diagnosis, and patients should be carefully followed-up to detect remnant stomach cancer.