Indication of Pylorus-prserving Gastrectomy from the Perspective of Peripyloric Lymph Node Metastasis

KANESHIRO Kazuhisa, ITO Seiji, MISAWA Kazunari, ITO Yuichi, NINOMIYA Go, ABE Tetsuya, KOMORI Koji, SENDA Yoshiki, SANO Tuyoshi, SHIMIZU Yasuhiro, KINOSHITA Taira

doi:10.3919/jjsa.75.2671

Abstract : A retrospective study was conducted to decide the indication for pylorus-preserving gastrectomies (PPG). We enrolled consecutive 2173 patients who were treated with distal gastrectomy or total gastrectomy along with lymphadenectomy more than D1 as radical operation for gastric cancer. The incidence of peripyloric lymph node metastasis was evaluated with reference to the depth of invasion, tumor size, and the tumor-pylorus ring distance. The positive rate of lymph node metastasis decreased in proportion to the tumor-pylorus ring distance. On the other hand, the rate increased in proportion to the tumor depth. Among pT1 cases with > 5 cm tumor-pylorus ring distance, peripyloric lymph node metastasis was detected in only 5 cases, which had >= 2 cm tumor size and pSM invasion. Then we set the clinical indication of PPG for cM and cSM (tumor diameter < 2 cm) with > 5 cm pylorus-tumor distance. In a re-evaluation made based on this indication criteria, there was only one (0.2%) case of positive lymph nodes out of 424 PPG indicated cases, however, this was unordinary case with bone metastases 4 years after operation regardless of D2 lymph node dissection. In conclusion, cM or cSM (< 2 cm) gastric cancer situated more than 5 cm distant from the pylorus ring can be a candidate for PPG.

Indication of Pylorus-prserving Gastrectomy from the Perspective of Peripyloric Lymph Node Metastasis

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