Laparoscopic Pylorus-preserving Gastrectomy For CT1N0M0 Cancer In The Middle Stomach-analysis Of Cases In One Year

Objective To analyze the cases with cT1N0M0 gastric cancer in the middle stomach who received laparoscopic pylorus-preserving gastrectomy(LPPG)and to evaluate the safety of the procedure as well as its value on the postoperative quality of life(QOL).Methods We retrospective analyzed the clinical data of surgically treated patients diagnosed as cT1N0M0 gastric cancer pre-operatively in the middle stomach during November 2018 to November 2019 in The 2nd Affiliated Hospital of Soochow University.Among the 27 patients,15 patients received LPPG,and the other 12 patients received laparoscopic distal gastrectomy(LDG).Results There were no significant differences in age,sex and BMI between LPPG and LDG.All patients received laparoscopic surgery successfully without conversion to open procedure.There were no significant differences in operation time,amount of bleeding,diameter of tumor,and resected lymph nodes between LPPG group and LDG group(P>0.05).Mean proximal(2.9cm±1.0cm vs 3.7cm±0.6cm,P=0.020)and distal resection margins(2.7cm±0.7cm vs 4.3cm±1.0cm,P=0.000)of LPPG group were shorter than LDG group.The distance from distal resection margin to pylorus of LPPG group was(3.5±0.7)cm.Postoperative pathology showed T1aN0M0 in 7 cases,T1bN0M0 in 4 cases,T1bN0M0 in 2 cases and T2N0M0 in 2 cases in the LPPG group,and T1aN0M0 in 3 cases and T1bN0M0 in 9 cases in the LDG group.NG tube was not placed in both groups routinely.There were no differences between LPPG and LDG in time to first flatus,time to first defecate,time to first fluid and time to drainage tube removal(P>0.05).Mean hospital stay after surgery of LPPG was longer than that of LDG(10.9d±9.6d vs 8.3d±1.1d),but there was no significant difference(P>0.05).The complications of LPPG included delayed gastric emptying in 3 cases(20%)and reflux esophagitis in 1 case(6.7%).The complications of LDG included anastomotic stenosis in 1 case(8.3%),refractory diarrhea in 1 case(8.3%)and incision infection in 1 case(8.3%).The nutritional status of LPPG group was better than that of LDG.Visick grading and Chew-wun Wu scale 3 months after operation revealed that QOL of LPPG was better than that of LDG.Neither recurrence nor death was found in both groups during the follow-up periodConclusion With similar incidence of short-term complications and better QOL,LPPG is a safe and feasible treatment for cT1N0M0 gastric cancer in the middle stomach.