Clinical outcomes of preserving antral branch of right gastroepiploic vein in laparoscopic pylorus-preserving gastrectomy: a retrospective analysis

Abstract

Background Delayed gastric emptying (DGE) is a significant complication in pylorus-preserving gastrectomy (PPG) which disturb the postoperative recovery. We modified the infrapyloric dissection to preserve the antral branch of right gastroepiploic vein (RGEV) in PPG as a preventive method of DGE and investigate the clinical outcomes. Methods Preservation of the antral branch of RGEV was reviewed of cT1N0M0 gastric cancer patients underwent PPG (n = 131) by a single surgeon during 2018–2020. Presence of DGE was evaluated by postoperative complications, gastric emptying scintigraphy (GES) and gastroscopy. DGE were compared between the antral branch preserved (a-PPG) group (n = 67) and sacrificed (c-PPG) group (n = 64). Clinicopathological features were also compared. Results Overall complication rate was similar between a-PPG and c-PPG group (p = 0.631). No one suffered from DGE with Grade Ⅲ in a-PPG group (0.0%) comparing with 5 cases in c-PPG with Grade III DGE (7.8%) (p = 0.026). The number of retrieved No.6 lymph nodes and 3-year recurrence-free survival were similar between two groups. At postoperative 3 months, DGE detected by GES was more frequent in c-PPG (23.8%) than in a-PPG (6.3%) (p = 0.032). Antral branch preservation (p = 0.037) was an independent risk factor of DGE according to multivariate analysis. Conclusions Antral branch of RGEV preservation may provide prevention from DGE for patients who undergo PPG.