Laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer: A retrospective study of long-term functional outcomes and quality of life
Laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer: A retrospective study of long-term functional outcomes and quality of life
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DOI：
10.3748/wjg.v25.i36.5494
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发表时间：
2019-09-28
影响因子：
4.3
通讯作者：
Kim, Young-Woo
中科院分区：
文献类型：
--
作者：
Eom, Bang Wool;Park, Boram;Kim, Young-Woo
研究背景与腹腔镜辅助远端胃切除术（LADG）相比，腹腔镜辅助幽门保留胃切除术（LAPPG）具有功能保留手术的优势。然而，在临床环境中，LAPPG后胃排空延迟和食管反流可能是严重的问题，使得外科医生不愿意进行LAPPG。目前尚不清楚LAPPG是否具有更好的远期功能结局和生活质量。方法回顾性分析了195例接受Billroth II吻合术的LADG患者和101例接受LAPPG治疗胃中三分之一cT1N0胃癌患者的临床病理资料在2012年到2015年间。比较两组术后并发症、营养指标、欧洲癌症研究与治疗组织问卷C30和STO22调查结果，LAPPG组血清血红蛋白水平明显高于LADG组（P < 0.001）。内镜检查中，LAPPG组胆汁反流发生率低于LADG组（P < 0.001），但食物残留发生率高于LADG组（P < 0.001）。关于生活质量评分，LAPPG组的身体功能评分更好（86.7 vs 90.0，P = 0.032），但与LADG组相比，疼痛和反流也更大[疼痛8.3 vs 16.7，11.1（四分位距，0，22.2）vs 11.1（四分位距，11.1，33.3），P = 0.034和0.001]。与采用Billroth II吻合术的LADG相比，其在疼痛和反流症状方面可能不利。
BACKGROUNDLaparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was known to have benefits of function-preserving surgery compared to laparoscopy-assisted distal gastrectomy (LADG). However, in clinical settings, delayed gastric emptying and esophageal reflux following LAPPG can be serious issues, making surgeons reluctant to perform LAPPG. It is unclear that LAPPG had better long-term functional outcomes and quality of life compared to LADG.AIMTo evaluate the long-term functional outcomes and patient-reported quality of life of LAPPG compared to those of LADG.METHODSWe reviewed the clinicopathological data of 195 patients who underwent LADG with Billroth II anastomosis and 101 patients who underwent LAPPG for cT1N0 gastric cancer in the middle third of the stomach between 2012 and 2015. Postoperative complications, nutritional parameters, and survey results of the European Organization for Research and Treatment of Cancer Questionnaire C30 and STO22 questionnaire were compared between the two groups.RESULTSThe serum hemoglobin level was significantly higher in the LAPPG group than in the LADG group (P < 0.001). In the endoscopic findings, incidence of bile reflux was lower (P < 0.001); however, the incidence of residual food was higher in the LAPPG group than in the LADG group (P < 0.001). Regarding the quality of life score, the LAPPG group had a better physical functioning score (86.7 vs 90.0, P = 0.032) but also greater pain and reflux when compared to the LADG group [8.3 vs 16.7 in pain, 11.1 (interquartile range, 0, 22.2) vs 11.1 (interquartile range, 11.1, 33.3) in reflux, P = 0.034 and 0.001, respectively].CONCLUSIONLAPPG is beneficial to recovery of anemia and to bile reflux, however, it might be unfavorable in terms of pain and reflux symptoms compared to LADG with Billroth II anastomosis.