Should pylorus-preserving gastrectomy be performed for overweight/obese patients with gastric cancer?

Abstract

BACKGROUND:

Pylorus-preserving gastrectomy is an alternative to distal gastrectomy for early gastric cancer, and is expected to have postoperative advantages including maintenance of body weight. Overweight/obesity is a risk factor for chronic disorders, including hypertension and diabetes mellitus; in these conditions, body weight control is frequently required as part of treatment. It remains unknown whether pylorus-preserving gastrectomy should be performed in overweight/obese patients because excess body weight may be maintained postoperatively.

METHODS:

We retrospectively investigated body weight changes and postoperative nutritional status of overweight/obese patients who underwent laparoscopic distal gastrectomy (LDG) or laparoscopic pylorus-preserving gastrectomy (LPPG) between 2006 and 2015. Among 349 overweight patients (BMI ≥ 25 kg/m2), 101 LDG and 101 LPPG cases were compared after propensity score matching to adjust for patient characteristics.

RESULTS:

The mean relative body weight ratios (postoperative/preoperative ratios) were 87.5 ± 8.0% after LDG and 89.6 ± 6.7% after LPPG (difference not significant, p = 0.088). The prealbumin level at 2 years and hemoglobin levels at 6 months, 1 year and 2 years were significantly well maintained after LPPG than after LDG. Prealbumin and hemoglobin levels at 2 years had almost returned to baseline levels in the LPPG group. The superiority of LPPG in the hemoglobin level was confirmed regardless of reconstruction methods after LDG.

CONCLUSIONS:

For overweight/obese patients, LDG and LPPG resulted in similar degrees of postoperative weight loss, with patients achieving near-ideal body weight. The postoperative nutritional advantages of LPPG were confirmed. LPPG seemed to be better even for overweight/obese patients who meet indication criteria.

• Authors: Masahiro Tsujiura, Naoki Hiki, Manabu Ohashi, Souya Nunobe, Koshi Kumagai, Satoshi Ida, Takuma Ohashi, Takeshi Sano, Toshiharu Yamaguchi
• Journal: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (Gastric Cancer) Vol. 22 Issue 6 Pg. 1247-1255 (11 2019) ISSN: 1436-3305 [Electronic] Japan
• PMID: 30888536 (Publication Type: Journal Article)

Topics

• Aged
• Female
• Gastrectomy (methods)
• Humans
• Laparoscopy (methods)
• Male
• Middle Aged
• Nutritional Status
• Obesity (complications)
• Overweight (complications)
• Postoperative Period
• Pylorus (surgery)
• Retrospective Studies
• Stomach Neoplasms (surgery)
• Weight Loss