The Clinical Evaluation of Vagus Nerve Preserving Gastric Operation with D2 Lymph Node Dissection for Early and Advanced Gastric Cancer

Hideki Tsuji, Shigemitsu Andoh and Kenichi Sakakibara

Department of Surgery, Toyota Memorial Hospital

We developed vagus nerve preservation gastric surgery with D2 lymph node dissection (VP-D2) which has cancer curability for maintaining digestive and absorptive function and decreasing the occurrence of gallstones for gastric cancer patients. Patients and Methods: The celiac branch of the vagus nerve is separated retrogradely by ligating and dissecting the trunk of the left gastric artery. This procedure makes it easy to save the celiac branch and to dissect No. 1 and 7 lymph node. VP-D2 includes pylorus preserving gastrectomy (VP-PPG), distal gastrectomy (VP-DG), proximal gastrectomy and total gastrectomy for patients with early gastric cancer and in the early stage of advanced gastric cancer. A total of 148 patients including 41 cases of advanced gastric cancer underwent VP-D2 between 1994 and March 2000 in our department. Subjects were 137 patients including 34 cases of advanced gastric cancer except 4 cases of recurrence and others. This surgery in advanced gastric cancer indicated for T2, N0 in the lesser curvature side or T3 (slight penetration of serosa), N1 in the greater curvature side by TNM clinical classification. We compared decreases in the body weight and the frequency of gallstone formation in 121 patients undergoing VP-DG and PPG, and in 66 patients undergoing conventional distal gastrectomy with trunkal vagotomy (D2-DG). Results: Stage of 137 patients was Stage I in 125, II in 7, III in 5. Recovery of the body weight was superior since three month after operation in the 121 who underwent VP-DG and PPG comparing in the 66 undergoing D2-DG, and body weight loss was 95.7% and 91.5% respectively, which was statistically significant (P<0.0001). Body weight loss in total gastrectomy was 90.2± 6.3% (n=10), and 94.3± 6.5% (n=6) in proximal gastrectomy. The frequency of gallstone formation was 1.7% (2/121) for VP-DG and PPG, and 13.6% (9/66) for D2-DG, statistically significant (P=0.0016). Conclusion: VP-DG and PPG improves the postoperative quality of life more than D2-DG. We applied curative VP-D2 for patients with early stage of advanced gastric cancer. It is considered that application of this operation for advanced gastric cancer requires further examination.

Key words
gastric cancer, preservation of vagus nerve, gastric surgery, quality of life

Reprint requests
Hideki Tsuji Department of Surgery, Toyota Memorial Hospital 1-1 Heiwa-cho, Toyota City, 471-8513 JAPAN

Accepted
November 27, 2002

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