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- Title
Should pylorus-preserving gastrectomy be performed for overweight/obese patients with gastric cancer?
- Authors
Tsujiura, Masahiro; Hiki, Naoki; Ohashi, Manabu; Nunobe, Souya; Kumagai, Koshi; Ida, Satoshi; Ohashi, Takuma; Sano, Takeshi; Yamaguchi, Toshiharu
- 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.
- Subjects
STOMACH cancer; BODY weight; WEIGHT loss; PROPENSITY score matching; REGULATION of body weight
- Publication
Gastric Cancer, 2019, Vol 22, Issue 6, p1247
- ISSN
1436-3291
- Publication type
Article
- DOI
10.1007/s10120-019-00951-x