Functional Evaluation of Pylorus-preserving Gastrectomy with Preservation of Vagal Nerve and Assessment of Its Postoperative Quality of Life

We investigated the utility of pylorus-preserving gastrecotmy (PPG) with preservation of the vagal nerve (hepatic branch, pyloric branch and celiac branch) in early gastric cancer. The study was designed to determine the postoperative quality of life (QOL) and functioning of several organs 1 year after the operation in 15 patients who underwent PPG and 15 patients who underwent conventional distal gastrectomy (DG) with truncal vagotomy as a control of radical lymph node dissection. Body weight loss, loss of appetite, reflux gastritis and esophagitis in the gastroscopic findings, and decrease in RBC and Hb in the laboratory findings were less frequent in the PPG than in the DG group. The abdominal symptom after meal was characteristic of the PPG group, which had neither diarrhea nor abdominal pain. The pattern of gastric emptying, contraction of the gallbladder and hormonal secretion resembled their preoperative patterns more closely in the PPG than in the DG group. PPG has a high potential of maintaining the QOL and the nutritional condition in gastric cancer patients. These virtues result from the following procedures: 1) preservation of the pyloric ring. 2) reduction of the extent of gastrectomy. 3) preservation of the vagal nerve.