Abstracts
2000 Digestive Disease Week

# 2333 Comparison of Postoperative Results Between Pylorus-Preserving Gastrectomy and Conventional Distal Gastrectomy for Early Gastric Cancer: A Prospective Randomized Study.
Iwao Sasaki, Ken-Ichi Shiiba, Hiroo Naito, Yuji Funayama, Sei-Ichi Ishii, Tsuneo Shiratori, Akio Ohuchi, Yoshikazu Asino, Yoshinobu Takahashi, Koumei Fujiya, Akihiro Iwatsuki, Seiki Matsuno, Sendai, Japan

Background: Pylorus-preserving gastrectomy (PPG) was originally applied to cases of benign gastric ulcer and hence did not include lymphnodedissection, which dissects extrinsic nerves and some vessels distributing to the stomach. PPG has been recently applied to cases with early gastric cancer as a function-preserving operation. However, postoperative morbidity of PPG with lymphnode-dissection remains unelucidated because the prospective randomized study has not been performed. Objective: To evaluate postoperative results of PPG with lymphnode-dissection in comparison with conventional distal gastrectomy (CDG) in patients with early gastric cancer. Design: Multicenter trial of prospective randomized study was performed in hospitals of the Tohoku area in Japan. All surgeons who entered the trial were well trained for these operative procedures. Patients: During four year trial period, 38 and 36 patients underwent PPG and CDG with Billroth I anastomosis, respectively. All patients were diagnosed as early gastric cancer, with either limited invasion of to the mucosal or submucosal layer. Results: There was no difference in background of patients (sex and mean age) between PPG and CDG. Level of lymphnode-dissection did not differ between PPG and CDG (PPG/CDG: D0 in 1/3 patients, D1 in 8/8, D1 alpha in 6/5, D2 in 22/19, D2 alpha in 1/0). Operative time was 3.0 hours in PPG and 3.2 hours in CDG (p>0.05). Intraoperative blood loss was 375 ml and 419 ml in PPG and CDG, respectively (p>0.05). Postoperative day for removal of naso-gastric tube was 2.9 days in PPG and 3.8 days in CDG. Nasogastric tube was reinserted in 4 patients with PPG and 3 patients with CDG because of postoperative gastric stasis. Body weight loss 1 month after operation was not different between PPG (4.5 kg) and CDG (4.8 kg). Postoperative hospital stay tended to be longer in CDG (32.5days) than PPG (29.6 days). Anastomotic leakage was observed in 2 cases with CDG. Two patients whose operative procedures were planned as PPG were converted to CDG during operation. Conclusions: Postoperative morbidity of PPG was the same as that of CDG. PPG with lymphnode-dissection is an operative procedure as safe as CDG and considered as a favorable reduction surgery for early gastric cancer.