Ann Surg Treat Res.  2023 Jan;104(1):18-26. 10.4174/astr.2023.104.1.18.

Comparison between laparoscopic pylorus-preserving gastrectomy and laparoscopic distal gastrectomy for overweight patients with early gastric cancer

• Lee HJ
• Alzahrani KM
• Kim SR
• Park JH
• Suh YS
• Park DJ
• Lee HJ
• Yang HK
• Kong SH

• KMID: 2537623
• DOI: http://doi.org/10.4174/astr.2023.104.1.18

Abstract

Purpose
Laparoscopic pylorus-preserving gastrectomy (LPPG) has a nutritional advantage over laparoscopic distal gastrectomy (LDG), however, may be less beneficial in overweight patients in terms of weight loss. The purpose of this study was to compare LPPG and LDG in overweight patients with early gastric cancer.
Methods
Clinicopathologic data of overweight patients (body mass index [BMI], ≥25 kg/m² ) who underwent LPPG (n = 63) or LDG (n = 183) in 2016–2018 were retrospectively reviewed. In the LDG group, patients with Billroth-II anastomosis were separately grouped (LDG B-II, n = 66). Changes in BMI, hemoglobin, albumin, and total protein were compared among groups.
Results
Changes in BMI were not significant different among groups. The LPPG group had significantly higher albumin than the LDG group at postoperative 6 months and 1 year. The LPPG group had higher total protein than the LDG group at postoperative 2 years. The LPPG group had a higher complication rate of Clavien-Dindo classification III or higher (20.6%) than the LDG group (8.2%, P = 0.007). However, after excluding pyloric stenosis, there was no significant difference among groups (LPPG vs. LDG, P = 0.290; LPPG vs. LDG B-II, P = 0.921).
Conclusion
LPPG and LDG groups showed similar weight loss. However, the LPPG group had higher albumin and protein levels than the LDG group of overweight patients. Thus, it is not necessary to select LDG only for weight loss. LPPG may be selected as one option due to its potential nutritional benefit when pyloric stenosis is properly managed.

Keyword

Gastrectomy; Overweight; Stomach neoplasms

Figure

• 

  Fig. 1 Flowchart showing the selection of study subjects. EGC, early gastric cancer; LPPG, laparoscopic pylorus-preserving gastrectomy; LDG, laparoscopic distal gastrectomy; BMI, body mass index; B-I, Billroth-I anastomosis; B-II, Billroth-II anastomosis; RY, Roux-en-Y anastomosis.

• 

  Fig. 2 Changes in body mass index (BMI) before and after surgery. Values are shown as mean ± standard deviation (mixed linear test). The P-value is the value of the time and group interaction test. 6 mo, 6 months postoperative; 1 yr, 1 year postoperative; 2 yr, 2 years postoperative; LPPG, laparoscopic pylorus-preserving gastrectomy; LDG, laparoscopic distal gastrectomy; B-II, Billroth-II anastomosis.

• 

  Fig. 3 Changes in nutritional indicators. Values are shown as mean ± standard deviation, mixed linear test. The P-value of hemoglobin is the time point and group interaction test value, and the P-value of albumin and total protein is the post-hoc test value comparing the groups at each time point. 6 mo, 6 months postoperative; 1 yr, 1 year postoperative; 2 yr, 2 years postoperative; LPPG, laparoscopic pylorus-preserving gastrectomy; LDG, laparoscopic distal gastrectomy; B-II, Billroth-II anastomosis. *P<0.05. †P-value of time and group interaction test.

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