SAGES 2026 Annual Meeting Emerging Technology Session

Laparoscopic pylorus-preserving gastrectomy vs Roux-en-Y distal gastrectomy forearly middle-third gastric cancer: Multicenter Western cohort with propensity score matching

BACKGROUND:

Early middle-third gastric cancerdemands oncologic cure withoutsacrificing function. Asian series suggest pylorus-preserving gastrectomymay improve outcomes versus distal gastrectomy with Roux-en-Y, butWestern uptake is limited and long-term oncologic and quality-of-lifeevidence remains scarce.

OBJECTIVE:

Compare mid-term oncologic outcomesand quality of life between laparoscopicpylorus-preserving gastrectomy (PPG) and distal gastrectomy with Roux-en-Y reconstruction (DGRY) in patients withearly-stage gastric cancer (EGC) located in the middle third of thestomach.

METHODS:

•Design: Multicenter retrospective cohort in three oncology centers in Medellín (2014–2022).

•Inclusion criteria: Early gastricadenocarcinoma cT1N0M0 in themiddle third/body, not suitable forendoscopic submucosal dissection.

•Exclusion criteria: Multifocal tumors, proximal/distal location outside thegastric body, intraoperativeconversion.

•Interventions: Pylorus-preservinggastrectomy (n=18) vs distal gastrectomy with Roux-en-Y reconstruction (n=36), all performedby experienced gastric oncologicsurgeons.

•Outcomes and statistics: Oncologicand perioperative safety outcomesplus long-term quality-of-lifeparameters (EORTC QLQ-STO22), compared between groups using bivariate analysis and propensityscore matching.

RESULTS

•Fifty-four patients with early gastriccancer were analyzed (PPG n=18; DGRY n=36) after excluding 7 cases due to advanced stage or conversion.

•Baseline and perioperative outcomeswere comparable, includingdemographics, comorbidities, tumor size, operative time, and blood loss. Table 1

•DGRY achieved higher lymph nodeyield and longer distal margins thanPPG (both p<0.01).

•Despite these technical differences, 3-year DFS and OS were comparable. Figure

•Both groups maintained high long-term quality of life, with PPG showingfavorable signals in reflux and appetite-related domains.Table 2

Why it matters: Western evidence on PPG remains limited. This study addresses whether function can be preserved without compromising oncologic outcomes in middle-third EGC.

CONCLUSIONS:

•In selected patients with middle-third EGC, laparoscopic PPG achieved comparable 3-year DFS and OS to DGRY.

•PPG showed favorable functional/QoL signals, particularly in reflux and appetite-related domains.

•These findings support PPG as a feasible function-preserving option in experienced Western centers.

TAKE HOME MESSAGE

PPG preserved 3-year oncologic outcomes without an apparent trade-off and showed favorable QoL signals in selected domains

SAGES 2026 Annual Meeting Emerging Technology Session

Oncologic and quality of life outcomes in pyloric-sparing laparoscopic gastrectomy vs. distal Roux-en-Y gastrectomy in early gastric cancer: a retrospective multicenter study with propensity score analysis

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