Pylorus-preserving gastrectomy for early middle gastric cancer (T1a-bN0M0) is safer and more effective than distal gastrectomy: a narrative review

As a treatment option for early middle gastric cancer, pylorus-preserving gastrectomy (PPG) has been shown to exhibit good clinical efficacy in Japan and Korea and has attracted widespread attention in China. PPG has a similar surgical safety to conventional distal gastrectomy (DG). The incidence of postoperative complications (such as dumping syndrome, bile reflux gastritis, gallstones, weight loss, and malnutrition) has been shown to be lower, while that of delayed gastric emptying (DGE) was higher after PPG than after DG. However, preserving the vagus nerve, blood supply to the pylorus, and adequate antral cuff length can effectively reduce DGE after PPG. Whether or not incomplete lymphadenectomy affects tumor safety is a primary focus for concern. According to the analysis of lymph node metastasis rates in early middle gastric cancer, the metastasis rates of lymph nodes No. 5 and No. 6 were low, providing a theoretical basis for performing limited lymph node dissection.