Laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer: A retrospective study of long-term functional outcomes and quality of life

Table 1 Clinicopathological characteristics and hospital course in the laparoscopy-assisted pylorus preserving gastrectomy and laparoscopy-assisted distal gastrectomy groups

Factors	Subgroup	LADG	LAPPG	P value
		(n = 195) (%)	(n = 101) (%)
Age (mean ± SD) (yr)		56.5 ± 11.8	58.3 ± 12.0	0.218
Sex	Male	114 (58.5)	54 (53.5)	0.458
	Female	81 (41.5)	47 (46.5)
BMI (mean ± SD) (kg/m2)		24.0 ± 3.1	24.1 ± 3.1	0.617
ASA	I	79 (40.5)	35 (34.7)	0.441
	II	109 (55.9)	64 (63.4)
	III	7 (3.6)	2 (2.0)
Tumor size (mean ± SD) (cm)		2.8 ± 1.5	2.5 ± 1.4	0.078
Histological type	WD	30 (15.4)	15 (14.9)	0.716
	MD	45 (23.1)	20 (19.8)
	PD	47 (24.1)	23 (22.8)
	SRC	70 (35.9)	43 (42.6)
	Others	3 (1.5)	0 (0)
Proximal margin (mean ± SD) (cm)		2.7 ± 2.0	2.5 ± 2.2	0.388
Distal margin (mean ± SD) (cm)		8.0 ± 2.5	3.6 ± 2.6	< 0.001
Number of positive LN (mean ± SD)		0.1 ± 0.3	0.1 ± 0.4	0.364
Number of Harvested LN (mean ± SD)		33.5 ± 12.2	30.5 ± 11.6	0.046
pT	1	188 (96.4)	96 (95.0)	0.551
	2	7 (3.6)	5 (5.0)
pN	0	182 (93.3)	92 (91.1)	0.641
	1	13 (6.7)	9 (8.9)
Operating time (median, IQR) (min)		150.0 (130.0, 185.0)	210.0 (185.0, 235.0)	< 0.001
Estimated blood loss (median, IQR) (cc)		100.0 (12.5, 200.0)	100.0 (50.0, 200.0)	0.235
Hospital stay (median, IQR) (d)		7.0 (6.0, 7.0)	7.0 (5.5, 7.0)	0.940

LADG: Laparoscopy-assisted distal gastrectomy; LAPPG: Laparoscopy-assisted pylorus preserving gastrectomy; SD: Standard deviation; BMI: Body mass index; ASA: American Society of Anesthesiologists physical status classification system; WD: Well differentiated; MD: Moderately differentiated; PD: Poorly differentiated; SRC: Signet ring cell; LN: Lymph node; IQR: Interquartile range.

Table 2 Early postoperative complications

Factors	Complications	LADG	LAPPG	P value
		(n = 195) (%)	(n = 101) (%)
Grade I	Wound	2	0	0.519
	Ileus	3	1
	Delayed gastric emptying	0	3
	Urologic problem	1	1
Grade II	Ileus	2	0	0.378
	Delayed gastric emptying	2	2
	Intra-abdominal abscess	0	1
	Intra-abdominal bleeding	1	0
	Acute cholecystitis	1	0
	Pulmonary problem	1	2
	Urologic problem	0	1
Grade III	Wound	2	0	0.282
	Delayed gastric emptying	0	4
	Anastomotic leakage	1	1
	Anastomosis bleeding	1	0
Grade IV	Septic shock	1	0	0.999
Overall Complications	Absent	179 (91.8)	86 (85.1)	0.108
	Present	16 (8.2)	15 (14.9)
Delayed gastric emptying	Absent	193 (99.0)	92 (91.1)	0.001
	Present	2 (1.0)	9 (8.9)

LADG: Laparoscopy-assisted distal gastrectomy; LAPPG: Laparoscopy-assisted pylorus preserving gastrectomy.

Table 3 Comparison of long-term quality of life between the laparoscopy-assisted pylorus preserving gastrectomy and laparoscopy-assisted distal gastrectomy groups

	LADG (n = 108)	LAPPG (n = 61)	P value
	Median (interquartile)	Median (interquartile)
EORTC QLQ C-30
Global health status/QoL	66.7 (50.0, 83.3)	66.7 (50.0, 83.3)	0.466
Functional scales
Physical functioning	86.7 (80.0, 93.3)	90.0 (86.0, 100.0)	0.032
Role functioning	100.0 (66.7, 100.0)	100.0 (83.3, 100.0)	0.07
Emotional functioning	83.3 (66.7, 100.0)	83.3 (75.0, 100.0)	0.757
Cognitive functioning	83.3 (83.3, 100.0)	83.3 (83.3, 100.0)	0.690
Social functioning	83.3 (83.3, 100.0)	83.3 (83.3, 100.0)	0.776
Symptom scales/items
Fatigue	22.2 (11.1, 33.3)	22.2 (11.1, 33.3)	0.845
Nausea and vomiting	0 (0, 16.7)	0 (0, 16.7)	0.916
Pain	0 (0, 16.7)	0 (0, 16.7)	0.779
Dyspnea	0 (0, 33.3)	0 (0, 33.3)	0.977
Insomnia	0 (0, 33.3)	0 (0, 33.3)	0.387
Appetite loss	0 (0, 0)	0 (0, 33.3)	0.070
Constipation	0 (0, 33.3)	0 (0, 33.3)	0.073
Diarrhea	16.7 (0, 33.3)	33.3 (0, 33.3)	0.718
Financial difficulties	0 (0, 33.3)	0 (0, 16.7)	0.809
EORTC QLQ STO-22
Dysphagia	0 (0, 11.1)	0 (0, 11.1)	0.722
Pain	8.3 (0, 25.0)	16.7 (8.3, 33.3)	0.034
Reflux	11.1 (0, 22.2)	11.1 (11.1, 33.3)	0.001
Eating restrictions	8.3 (0, 16.7)	8.3 (0, 25.0)	0.599
Anxiety	22.2 (11.1, 33.3)	22.2 (11.1, 38.9)	0.949
Dry mouth	33.3 (0, 33.3)	0 (0, 33.3)	0.204
Taste	0 (0, 0)	0 (0, 0)	0.091
Body image	0 (0, 33.3)	33.3 (0, 33.3)	0.847
Hair loss	33.3 (0, 66.7)	33.3 (16.7, 33.3)	0.875

LADG: Laparoscopy-assisted distal gastrectomy; LAPPG: Laparoscopy-assisted pylorus preserving gastrectomy; EORTC: European Organization for Research and Treatment of Cancer; QLQ: Quality of life questionnaire.