Totally Laparoscopic Distal Gastrectomy VS Pylorus-Preserving Gastrectomy for Early Gastric Cancer in the Middle Stomach

With the development of laparoscopic technology, the surgical treatment of early gastric cancer (EGC) has shifted towards minimally invasive, precise, and function-preserving strategies. Totally laparoscopic distal gastrectomy (TLDG) and totally laparoscopic pylorus-preserving gastrectomy (TLPPG) are minimally invasive procedures. However, there is a lack of systematic evidence to directly compare their efficacies. This study focuses on two fully laparoscopic techniques, TLDG and TLPPG, to address two key objectives: (1) whether TLPPG can avoid the long-term functional sequelae of TLDG while ensuring oncological safety, including complications (delayed gastric emptying, reflux, and dumping syndrome), postoperative quality of life (assessed via the PGSAS-37 scale), and survival outcomes; and (2) the balance between complications and survival in function-preserving surgery. The findings aim to provide critical technical parameters for individualized surgical decision-making in EGC.

Sex

All

Minimum age

18 Years

Maximum age

85 Years

Inclusion Criteria:

* Preoperative diagnosis of early gastric adenocarcinoma (invasion limited to the mucosa or submucosa) confirmed by tissue biopsy, abdominal enhanced CT, and endoscopic ultrasound;
* Tumor located in the gastric body or distal stomach, \>4 cm from the pylorus;
* Ineligible for endoscopic mucosal dissection or elected for surgical treatment by family;
* Complete clinical and pathological data.

Exclusion Criteria:

* Severe anemia, coagulation disorders, or gastric outlet obstruction;
* History of gastric or upper abdominal surgery;
* Concurrent malignant tumors, ascites, edema, or pleural effusion;
* Gastric ulcers, polyps, or intestinal metaplasia.