Application Value Of Laparoscopy-assisted Pylorus-preserving Gastrectomy In Early Gastric Cancer

Objective:Distal gastrectomy for the treatment of early gastric cancer in the middle 1/3of the stomach with poor postoperative nutritional status and higher long-term postoperative complications.Pylorus-preserving gastrectomy(PPG)can make up the disadvantage of distal gastrectomy when treat early gastric cancer,improving the quality of life and reducing the incidence of long-term adverse events after gastrectomy.In this study,we performed retrospective analysis aim to compare the advantages and disadvantages of laparoscopic-assisted pylorus-preserving gastrectomy(LAPPG)and laparoscopy-assisted distal gastrectomy(LADG)during treat early gastric cancer(EGC),and to provide recommendations for treating the increasing number of EGC cases.Methods:A retrospective cohort study was utilized.Patients meet follow criteria were included in our study whose EGC lesion was located in the middle 1/3 of the stomach,and undergoing preoperative gastroscopy,ultrasound gastroscopy,multi-slice spiral CT,pathological biopsy confirmed early gastric cancer(the lesion was located in the mucosa and submucosa,imaging examination did not show positive perigastric lymph nodes and distant metastasis),underwent selective operation.According to the inclusion and exclusion criteria,we collected the clinicopathological data of 52 patients who underwent laparoscopic surgery for treatment of EGC in the Department of Gastrointestinal Surgery of our Hospital from September 2018 to August 2020.Among them,21 cases underwent LAPPG,and 31 cases underwent LADG.Analysis indicators include:general data,intraoperative data,postoperative pathological data and recovery status,nutritional status preoperative、1 and 3 months after gastrectomy,postoperative complications and the scores of Postgastrectomy Syndrome Assessment Scale(PGSAS-45)questionnaires.Utilizing SPSS 26.0 software for statistical analysis.Performing t test for the comparison between two groups and the count data was tested by X~2,P<0.05 was considered statistically significant.Results:General data:No significant differences in BMI,age,and gender between the two groups(P>0.05).Intraoperative data:The average operation time and intraoperative blood loss of the LAPPG and LADG groups were 173.3±30.4min,82.8±30.2ml;and144.3±30.9min、70.5±35.1ml,respectively,with statistical difference in operation time(p=0.002).Postoperative recovery:The postoperative exhaust time of the two groups were 3(2-4)(d)and 3(2-5)(d),and the postoperative fluid intake time was 4(3-5)(d)and 4(2-6)(d),respectively,with no statistical difference.In terms of nutritional indicators,with no difference between LAPPG group and LADG group preoperative and 1 month after surgery.The average values of hemoglobin(Hb)and albumin(ALB)in the LAPPG group were 128.7±16.0g/L and 41.2±4.8g/L respectively3 months after gastrectomy;the difference was statistically significant compared with the LADG group(p=0.016 and p=0.041).The overall incidence of complications during hospitalization in the LAPPG and LADG groups were 9.5%and 3.2%,respectively.During the follow-up period,the incidence of long-term complications in the LAPPG and LADG groups were 9.5%and 19.3%,respectively.According to the Clavin-Dindo classification,The incidence of grade II and above complications was not statistically significant in the LAPPG group(19.0%)and LADG group(22.6%)(p=0.934).The PGSAS-45 questionnaire scoring results show that LAPPG scores lower in the dumping syndrome and life dissatisfaction subscales,indicating its advantages in improving the quality of daily life.During the follow-up period,no patients had recurrence of remnant gastric cancer,and no patients in the two groups had tumor-related deaths or other deaths.Conclusion:Compared with LADG,LAPPG has parallel feasibility and surgical safety in the treatment of early gastric cancer;LAPPG has the advantages of improving postoperative low nutritional status and promoting early recovery of patients,and can optimize the quality of life of EGC patients.LAPPG is an alternative surgical treatment for early gastric cancer patients with lesion located in 1/3 of stomach,the short-term result is clear,and the long-term result will be confirmed by further studies.