Reflux Esophagitis After Laparoscopic Pylorus-Preserving Gastrectomy for Gastric Cancer

Background: Laparoscopic pylorus-preserving gastrectomy (LPPG) is performed for cT1N0 gastric cancer as a function-preserving surgery, but reflux esophagitis can develop as a mid- to long-term complication postoperatively. We aimed to clarify the incidence rate of this complication and the factors correlated with it. Methods: Patients with gastric cancer who underwent LPPG between 2005 and 2017 were analyzed. Postoperative reflux esophagitis was evaluated with esophagogastroduodenoscopy; patients were diagnosed as having reflux esophagitis with erosive esophagitis using the modified Los Angeles classification. The incidence rate of postoperative reflux esophagitis was estimated; factors correlated with postoperative reflux esophagitis were analyzed using the logistic regression model. Results: During the study period, 813 patients underwent LPPG for gastric cancer, and 127 (15.6%) of them developed grade B or more severe postoperative reflux esophagitis. The factors correlated with postoperative reflux esophagitis were male sex (odds ratio, 2.68; 95% confidence interval, 1.77-4.05; P < 0.001), preoperative grade A reflux esophagitis (odds ratio, 3.05; 95% confidence interval, 1.28-7.27; P = 0.012), body mass index of & GE; 23 kg/m(2) at 1 year postoperatively (odds ratio, 2.18; 95% confidence interval, 1.34-3.53; P = 0.002), postoperative hiatal hernia (odds ratio, 4.35; 95% confidence interval, 2.35-8.04; P < 0.001), and long-term stasis (odds ratio, 1.58; 95% confidence interval, 1.01-2.47; P = 0.044). Conclusions: Careful attention should be paid in performing LPPG and in postoperative management after LPPG for gastric cancer patients with those risk factors.

Automated summary

This study analyzed patients with gastric cancer who underwent laparoscopic pylorus-preserving gastrectomy (LPPG) and found that reflux esophagitis is one of the mid- to long-term complications. The study identified several factors associated with postoperative reflux esophagitis, including male sex, preoperative reflux esophagitis, body mass index ≥ 23 kg/m2 at 1 year postoperatively, postoperative hiatal hernia, and long-term stasis. Therefore, careful attention should be paid in performing LPPG and in postoperative management for gastric cancer patients with these risk factors.