Objective: To evaluate the function of the remnant stomach after proximal subtotal gastrectomy for cardiac cancer and to improve the life quality of post-surgical patients.
Methods: 17 patients with cardiac cancer underwent proximal subtotal gastrectomy combined with disconnection of pyloric sphincter (PSG + DPS) by finger pressing. Intraoperative pyloric manometric studies were performed in the 17 patients before and after DPS. Five subjects who underwent laparotomy for non-esophagogastric reasons was taken as controls. Total bile acids (TBA) in gastric juice was tested in the 17 patients at 5th postoperative day, and radionuclide gastric emptying was also studied from the 18th to 20st postoperative day.
Results: Both pyloric resting pressure and pyloric contracting pressure were significantly decreased after DPS (P > 0.01). In comparison with normal subjects, PCP was increased before DPS (P > 0.01) and decreased after the procedure (P < 0.05). However, PRP did not show significant differences before (P > 0.05) and after (P > 0.05) DPS. There were no significant differences regarding TBA content in gastric juice in PSG + DPS group, PSG group, and normal subjects (P > 0.05). The time required for the stomach to empty half of its radioactive contents (T1/2) was longer in the patients having PSG only than those undergoing PSG + DPS (P < 0.01) and normal controls (P < 0.05). However, there were no significant differences regarding T1/2 between the patients with PSG + DPS and normal controls (P > 0.05).
Conclusions: The emptying of remnant stomach after subtotal gastrectomy for cardiac cancer is delayed because of the increase of emptying-resistance and decrease of peristalsis. PSG combined with DPS not only improves gastric emptying, but also prevents duodenogastric reflux. Consequently, postoperative life quality of the patients with cardiac cancer can be effectively improved.