JCT  Vol.8 No.10 , October 2017
Relationships between Length of the Antral Cuff and Postgastrectomy Disorders and Gastric Empting Function in Patients after Pylorus-Preserving Gastrectomy for Early Gastric Cancer
ABSTRACT
Objectives: To clarify the optimal length of the antral cuff (LAC) in patients after pylorus-preserving gastrectomy (PPG), we investigated relationships between LAC and postgastrectomy disorder (PGD) such as postprandial abdominal fullness (PAF), and between LAC and gastric empting function (GEF) in PPG patients. Background: The main cause of PGD in PPG patients has been considered to be LAC. Relationships between LAC and PGD and GEF in PPG patients are still unknown. Methods: Of 50 patients who underwent PPG in our hospital from January 2001 to December 2015 were divided into 2 groups [Group A, short LAC of 1.5 to 2.5 cm (n = 24); Group B, long LAC of 2.6 to 3.5 cm (n = 26)]. The relationships among LAC, PGD, and GEF were retrospectively studied. Results: LAC was clearly shorter in group A than group B (P < 0.01). PAF, appetite and food consumption per meal were clearly more favorable in group B than in group A (P < 0.01, respectively). Symptomatic reflux esophagitis (RE), early dumping syndrome, decreased percent body weight for pre-illness, endoscopic RE and endoscopic gastritis in the remnant stomach were more frequent in group A than group B. Gastric stasis in the remnant stomach was clearly more frequent in group A than group B (P < 0.01). GEF with the solid diet in group A was clearly more delayed than in group B (P < 0.01). Conclusions: Patients with a short LAC showed worse postoperative QOL and delayed GEF with the solid diet compared with a long LAC.
Cite this paper
Tomita, R. , Sakurai, K. and Fujisaki, S. (2017) Relationships between Length of the Antral Cuff and Postgastrectomy Disorders and Gastric Empting Function in Patients after Pylorus-Preserving Gastrectomy for Early Gastric Cancer. Journal of Cancer Therapy, 8, 867-879. doi: 10.4236/jct.2017.810076.
References
[1]   Park, d.J., Lee, H.J., Jung, H.C., Kim, W.H., Lee, K.U. and Yang, H.K. (2008) Clinical Outcome of Pylorus-Preserving Gastrectomy in Gastric Cancer in Comparison with Conventional Distal Gastrectomy with Billroth Ianastomosis. World Journal of Surgery, 32, 1029-1034. PMID: 18256877

[2]   Shibata, C., Sanijo, F., Kakyo, M., Kinouchi, M., Tanaka, N., Sasaki, I., et al. (2012) Currentstatus of Pylorus-Preserving Gastrectomy for Treatment of Gastric Cancer: A Questionnaire Survey and Review of Literatures. World Journal of Surgery, 36, 858-863. PMID: 22350486
https://doi.org/10.1007/s00268-012-1491-6

[3]   Song, P., Lu, M., Pu, F., Zhang, D., Wang, B. and Zhao, Q. (2014) Meta-Analysis of Pylorus-Preserving Gatrectomy for Middle-Third Early Gastric Cancer. Journal of Laparoendoscopic & Advanced Surgical Techniques, 24, 718-728. PMID: 25243417
https://doi.org/10.1089/lap.2014.0123

[4]   Namikawa, T., Hiki, N., Kinami, S., Okabe, H., Unshihara, T., Kawahira, H., et al. (2014) Factors That Minimize Postgastrectomy Symptoms Following Pylorus-Preserving Gastrectomy: Assessment Using a Newly Developed Scale (PGASAS-45). Gastric Cancer, 18, 397-406.
https://doi.org/10.1007/s10120-014-0366-y

[5]   Tomita, R., Takizawa, H. and Tanjoh, K. (1998) Physiological Effects of Cisapride on Gastric Emptying after Pylorus-Preserving Gastrectomy for Early Gastric Cancer. World Journal of Surgery, 22, 35-41. PMID: 24760336
https://doi.org/10.1007/s002689900346

[6]   Nakabayashi, T., Mochiki, E., Garcia, M., Haga, N., Suzuki, T., Asao, T., et al. (2002) Pyloric Motility after Pylorus-Preserving Gastrectomy with or without Pyloric Branch of the Vagus Nerve. World Journal of Surgery, 26, 577-583. PMID: 12098048
https://doi.org/10.1007/s00268-001-0270-6

[7]   Murakami, H., Matsumoto, H., Kubota, H., Higashida, M., Nakamura, M. and Hirai, T. (2013) Evaluation of Electrical Activity after Vagus Nerve-Preserving Distal Gastrectomy Using Multichannel Electrogastrography. Journal of Smooth Muscle Research, 49, 1-14. PMID: 23832614
https://doi.org/10.1540/jsmr.49.1

[8]   Imada, T., Rino, Y., Takahashi, M., Hatori, S., Tanaka, J., Shiozawa, M., et al. (1998) Gastric Emptying after Pylorus-Preserving Gastrectomy in Comparison with Conventional Subtotal Gastrectomy for Early Gastric Carcinoma. Surgery Today, 28, 135-138. PMID: 9525000
https://doi.org/10.1007/s005950050094

[9]   Koyama, K., Sasaki, I., Naito, H., Tsuchiya, T., Funayama, Y., Shibata, C., et al. (1995) Gastric Emptying of Semi-Solid Meal in Normal Man with Special Reference to Relationship between Plasma Acetoaminophen Concentrations and Gastric Emptying. Journal of Smooth Muscle Research, 31, 61-65. PMID: 7549050
https://doi.org/10.1540/jsmr.31.61

[10]   Christian, P.E., Datz, F.L. and Sorenson, J.A. (1983) Comparison of Tc-99m Labeled Liver and Liver Pate as Markers for Solid-Phase Gastric Emptying. Journal of Nuclear Medicine, 24, 264-268. PMID: 6210765

[11]   Nomura, E., Isozaki, H., Fujii, K., Toyoda, M., Niki, M., Sako, S., et al. (2003) Postoperative Evaluation of Function-Preserving Gastrectomy for Early Gastric Cancer. Hepatogastroenterology, 50, 2246-2250.

[12]   Nakane, Y., Michiura, T., Inoue, K., Sato, M., Nakai, K. and Yamamichi, K. (2002) Length of the Antral Segment in Pylorus-Preserving Gastrectomy. British Journal of Surgery, 89, 220-224.
https://doi.org/10.1046/j.1365-2168.2002.01984.x

[13]   Oh, S.Y., Lee, H.J. and Yang, H.K. (2016) Pylorus-Preserving Gastrectomy for Gastric Cancer. Journal of Gastric Cancer, 16, 63-71.
https://doi.org/10.5230/jgc.2016.16.2.63

[14]   Japanese Gastric Cancer Association (2011) Japanese Classification of Gastric Carcinoma. 3rd English Edition, Gastric Cancer, 14, 101-112.
https://doi.org/10.1007/s10120-011-0041-5

[15]   Sawai, K., Takahashi, T., Fujioka, T., Minato, H., Taniguchi, H. and Yamaguchi, T. (1995) Pylorus-Preserving Gastrectomy with Radical Lymph Node Dissection Based on Anatomical Variation of the Infrapyloric Artery. The American Journal of Surgery, 170, 1029-1036.

[16]   Kiyokawa, T., Hiki, N., Nunobe, S., Honda, M., Ohashi, M. and Sano, T. (2017) Preserving Inflapyloric Vein Reduces Postoperative Gastric Stasis after Laparoscopic Pylorus-Preserving Gastrectomy. Langenbeck’s Archives of Surgery, 402, 49-56.
https://doi.org/10.1007/s00423-016-1529-6

[17]   Morita, S., sassako, M., Saka, M., Fukagawa, T., Sano, T. and Katai, H. (2010) Correlation between the Length of Pyloric Cuff and Postoperative Evaluation after Pylorus-Preserving Gastrectomy. Gastric Cancer, 13, 109-116.
https://doi.org/10.1007/s10120-010-0549-0

[18]   Tokunaga, M., Hiki, N., Fukunaga, T., Ohyama, S., Nunobe, S., Yamada, K., et al. (2011) Is Preservation of Celiac Branch of the Vagal Nerve Effective in Preventing Stasis Following Pylorus-Preserving Gastrectomy? Hepatogastroenterology, 58, 1046-1050.

[19]   Morita, S., Katai, H., Saka, M., Fukagawa, T., Sano, T. and Sasako, M. (2008) Outocome of Pylorus-Presrving Gastrectomy for Early Gastric Cancer. British Journal of Surgery, 95, 1429.
https://doi.org/10.1002/bjs.6295

[20]   Phillips, R.J., Baronowsky, E.A. and Powley, T.L. (1997) Afferent Innervation of Gastrointestinal Tract Smooth Muscle by the Hepatic Branch of the Vagus. Journal of Comparative Neurology, 28, 248-270.
https://doi.org/10.1002/(SICI)1096-9861(19970728)384:2<248::AID-CNE6>3.0.CO;2-1

[21]   Stevens, J.E., Doran, S., Russo, A., O’Donovan, D., Feinle-Bisset, C., Rayner, C.K., et al. (2009) Effects of Intravenous Fructose on Gastric Emptying and Antropyloroduodenal Motility in Healthy Subjects. American Journal of Physiology. Gastrointestinal and Liver Physiology, 297, G1274-G1280.
https://doi.org/10.1152/ajpgi.00214.2009

[22]   Tomita, R., Fujisaki, S. and Tanjoh, K. (2003) Pathophysiological Studies on the Relationship between Postgastrectomy Syndrome and Gastric Emptying Function at 5 Years after Pylorus-Preserving Distal Gastrectomy for Early Gastric Cancer. World Journal of Surgery, 27, 725-733.
https://doi.org/10.1007/s00268-003-6906-y

[23]   Mistiaen, W., Van Hee, R., Blockx, P., Bortier, H. and Harrisson, F. (2001) Gastric Emptying Rate for Solid and for Liquid Test Meals in Patients with Dyspeptic Symptoms after Partial Gastrectomy and after Vagotomy Followed by Partial Gastrectomy. Hepatogastroenterology, 48, 299-302.

[24]   Spoo, J.W. and Shelton, G.D. (2014) Recurrent Gastric Dilatation and Intestinal Dysmotility Possibly Resulting from Autonomic Neuropathy in a Great Dane. Journal of the American Animal Hospital Association, 50, 221-226.
https://doi.org/10.5326/JAAHA-MS-6176

 
 
Top