Progressive improvement of prognosis for patients with gastric cancer (dynamic stage grouping) with increasing survival interval from initial staging: how much longer can a given survivor expect to live?

Conditional survival in patients treated for gastric cancer with a curative intent

BACKGROUND AND OBJECTIVES

Conditional survival (CS) provides the probability that a patient who has already survived a certain number of years after treatment will survive an additional number of years. We aim to study the CS of patients with gastric cancer.

METHODS

Patients who underwent curative intent treatment for gastric cancer in a single institution between 2007 and 2018 were included in the analysis. The probability (CS) that a patient who has already survived x years will survive an additional y year, was calculated as CS (y/x) = S(x + y)/S(x).

RESULTS

The probability of surviving an additional 3 years if a patient had already survived 1, 2, 3, 4, and 5 years after treatment were 64.2%, 74.5%, 81.6%, 83.2%, and 88.2%, respectively whereas the 4-, 5-, 6-, 7-, and 8-year actuarial OS were only 47.2%, 43.2%, 41%, 39.4%, and 38.2%, respectively. The independent prognostic factors associated with poor survival were age >60 years, T stage ≥T3, N stage ≥N2, proximal tumor location, and lymph node ratio > 0.18. Patients with these high-risk features showed the greatest increase in CS3 over time.

CONCLUSION

CS estimates provided a more dynamic prognostic information over time for patients treated for gastric cancer with curative intent.

Conditional cause-specific survival after chemotherapy and local treatment for primary stage IV breast cancer: A population-based study

Background

Conditional survival (CS) represents the probability of surviving for additional years after the patient has survived for several years, dynamically describing the survival rate of the patient with the varying time of survival. The aim of this study was to evaluate the conditional cause-specific survival (CCSS) after chemotherapy and local treatment for metastatic breast cancer, and to identify the prognostic factors affecting the CCSS.

Methods

Patients diagnosed with primary stage IV breast cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 were included. CS is defined as the probability of additional survival for y years after the patient had survived x years with the calculation formula CCSS (x | y) = CSS (x + y)/CSS (x), where CSS(x) indicates the patient’s cause-specific survival rate at the time of x years. Cox proportional hazard models were used to evaluate predictors of CCSS.

Results

A total of 3,194 patients were included. The 5-year CSS was 39%, whereas the 5-year CCSS increased to 46%, 57%, 71%, and 85% after the diagnosis of 1, 2, 3, and 4 years. For patients with adverse clinical pathological features, CCSS had more pronounced increase with survival time and is more different from the CSS at diagnosis. No matter at the time of diagnosis or 1 year or 3 years after diagnosis, HER2 status, local treatment, and multisite metastasis were independent prognostic factors that affect the long-term survival of patients (all P < 0.05).

Conclusion

The 5-year CCSS of patients with stage IV breast cancer was extended as the survival years increased. HER2 status, multisite metastasis, and local treatment were independent prognostic factors even 3 years after diagnosis.

Conditional survival for high-risk early-stage cervical cancer patients with lymph node metastasis after hysterectomy

BACKGROUND

To estimate conditional survival (CS) for high-risk early-stage cervical cancer patients with lymph node metastasis after hysterectomy.

METHODS

1964 T_1-2N₁M₀ cervical cancer patients who underwent primary hysterectomy from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Result (SEER) Program. Univariate and multivariate cox regression analysis were used to identify independent risk factors. 5-year conditional disease-specific survival (CDS5) and 5-year conditional relative survival (CRS5) were estimated. CDS5 and CRS5 stratified by risk factors were further calculated.

RESULTS

CDS5 and CRS5 increased from 71.0% and 73.7% at 0-year to 89.2% and 91.7% at 5-year, respectively. Inversely, the actuarial disease-specific survival and RS dropped from 71.0% and 73.7% at 5-year to 63.3% and 67.6% at 10-year, respectively. Patients with unfavorable factors had a bigger gap between actuarial survival and CS. Both CDS5 and CRS5 curves across stratas of each prognostic factor had a tendency to level off with time elapsing. Notably, CRS5 couldn't exceed 95% even after 5-year follow-up except for patients with grade I disease (CRS5 at 5-year: 100%) or tumor size less than 2 cm (CRS5 at 5-year: 96%).

CONCLUSION

CS increased over time while actuarial survival decreased as time passed. Patients with unfavorable factors had bigger improvement in CS than those with favorable factors. Excess mortality still existed in these patients after 5-year follow-up compared to the general population except for patients with grade I disease or tumor size <2 cm, who might gradually decrease follow-up times after 5-year.

Conditional Survival of female patients with operable invasive Breast Cancer in US: A population-based study

Background: Conditional survival (CS) is used to describe the dynamic possibility of survival, considering the changes of death risk with time lapsing. This study aimed to estimate the conditional disease-specific survival (CDS) for the female with operable invasive breast cancer.

Methods: The data was obtained from Surveillance, Epidemiology, and End Result Program of the National Cancer Institute. The hazard rate was calculated using kernel density smoothing method. The disease-specific survival (DSS) rates were estimated and compared using Kaplan-Meier method and log-rank test. The Cox regression model was used to adjust confounding factors. The CDS was calculated by CDS(y|x)=DSS(x + y)/DSS(x), where DSS(x) representatives the DSS at x year.

Results: The 5-year, 10-year, and 15-year DSS was 88.7%, 82.0%, and 78.3%, respectively. The hazard rate after surgery increased initially and peaked at about 1.5 years, then decreased gradually. Meanwhile, the CDS decreased just after surgery then increased continuously, which showed a contrary trend with hazard rate. Patients with high risk factors had greater survival gap between cumulative DSS and CDS. The changing trend of CDS in patients with high risk factors was more significant, and the CDS gap between low-risk patients and high-risk patients gradually decreased over time.

Conclusion: CS could provide a more precise long-term prognostic evaluation compared to traditional cumulative survival, especially for long-time survivors with high risk.

Changing odds of survival over time among patients undergoing surgical resection of extremity soft tissue sarcoma

BACKGROUND

While survival after surgical treatment of extremity soft tissue sarcoma (STS) is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant as it accounts for time already survived. We compared actuarial survival and CS of STS patients.

MATERIALS AND METHODS

We analyzed 567 patients who underwent surgery for localized extremity STS. Actuarial survival was estimated using the Kaplan-Meier method. Cox proportional hazards model was used to evaluate factors associated with disease-specific survival. Five-year CS (CS5) estimates at "χ" year(s) after surgery were calculated as CS5 = S(χ + 5)/S(χ).

RESULTS

Whereas actuarial survival decreased over time, CS5 increased. The postsurgical 1-, 3-, and 5-year CS5 values were 84.5%, 90.0%, and 93.8%, respectively, whereas the 6-, 8-, and 10-year actuarial survival rates were 82.0%, 79.4%, and 78.5%, respectively. The calculated CS5 exceeded actuarial survival especially in patients with risk factors such as large tumor size and Federation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) grades 2 and 3 tumors. Patients with tumor size ≥5 cm had an actuarial survival of 73.9% at 10 years compared to a CS5 of 95.4% in patients alive at 5 years. Likewise, patients with FNCLCC grade 3 tumors had an actuarial survival of 71.1% at 10 years compared to a CS5 of 96.0% in patients alive at 5 years.

CONCLUSIONS

Survival estimation by determination of CS can be dynamic and accurate especially in high-risk patients. CS can be useful for survival prediction and clinical decision making in extremity STS patients.

Conditional survival of patients with gastric cancer who undergo curative resection: A multi-institutional analysis in China

BACKGROUND

Conditional survival estimates, which take into consideration the changing risk with increasing survival time, provide a dynamic survival probability and more accurate survival information for clinician decision making. The objective of the current study was to evaluate the conditional disease-specific survival (DSS) for patients with gastric cancer who underwent curative surgery in China.

METHODS

In total, 7658 patients with gastric cancer from a multi-institutional cohort in China were included in the analyses. Actuarial DSS was estimated using the Kaplan-Meier method. Three-year conditional DSS (CDS₃ ) of patients who had already survived for x years was estimated as CDS₃ = DSS(x + 3)/DSS(x). Cox proportional hazards regression analyses were used to identify the factors related to DSS.

RESULTS

The 1-year, 3-year, and 5-year actuarial DSS rates were 88.2%, 64.5%, and 54.6%, respectively. By using CDS estimates, the probabilities that patients would remain alive for an additional 3 years given that they had already survived for 1, 3, and 5 years were 66.6%, 80.2%, and 88.3%, respectively. Patients who had unfavorable tumor characteristics diagnosed initially at surgery had the greatest improvement in CDS and the largest survival gap between actuarial DSS and CDS.

CONCLUSIONS

The current results indicate that CDS estimates for Chinese patients with gastric cancer who underwent surgery were dynamic and increased with time elapsed. Patients who had unfavorable tumor characteristics had the greatest improvement in CDS. This valuable information could provide more a precise evaluation of long-term prognosis and may serve as an important prognostic index in clinical practice. Cancer 2018;124:916-24. © 2017 American Cancer Society.

A Randomized Controlled Trial of Vagus Nerve-preserving Distal Gastrectomy Versus Conventional Distal Gastrectomy for Postoperative Quality of Life in Early Stage Gastric Cancer Patients

OBJECTIVE

To compare the postoperative quality of life of vagus nerve preserving distal gastrectomy (VPG) vs conventional distal gastrectomy (CG) in patients with early-stage gastric cancer.

DESIGN

Randomized controlled clinical trial.

SETTING

Large tertiary comprehensive cancer center in Korea.

PARTICIPANTS

One hundred sixty-three patients with early gastric cancer 18 years of age or older expected to undergo curative gastric resection.

INTERVENTION

Patients were randomized 1:1 to VPG (n = 85) or CG (n = 78).

MAIN OUTCOME MEASURES

European Organization for Research and Treatment of Cancer (EORTC) gastric module (STO22).

RESULTS

Patients assigned to VPG showed less diarrhea 3 and 12 months after surgery (P = 0.040 and 0.048, respectively) and less appetite loss at 12 months (P = 0.011) compared with those assigned to CG. In both groups, fatigue, anxiety, eating restriction, and body image deteriorated at 3 months after surgery and did not regain baseline levels 12 months after surgery. There were no significant differences between the 2 groups in cancer recurrence and death over 5 years of follow-up.

CONCLUSIONS

Early gastric cancer patients undergoing VPG reported significantly less diarrhea and appetite loss at 12 months postsurgery compared with those undergoing CG, with no differences in long-term clinical outcomes. VPG may improve the quality of life after gastrectomy in early gastric cancer patients compared with CG.

Conditional survival analysis in Korean patients with gastric cancer undergoing curative gastrectomy

BACKGROUND

Conditional survival (CS) measures the probability that patients will survive an additional number of years given that they have already survived for a certain period of time.

METHODS

In total, 2935 gastric cancer patients who had undergone curative gastrectomy between 1995 and 2011 were enrolled. The Cox proportional hazard regression model was used to evaluate the factors associated with overall survival (OS). Three-year CS estimates at 't' years after surgery were calculated as follows: CS(t) = S(t + 3)/S(t).

RESULTS

The 1-, 2-, 3-, 4- and 5-year OS rates of the 2935 patients were 96.6 %, 92.0 %, 88.7 %, 85.6 and 82.7 %, respectively. The probability of surviving an additional 3 years on the condition of having already survived 1, 2, 3, 4 and 5 years after surgery were 88.6 %, 89.9 %, 91.0 %, 92.2 % and 93.2 %, respectively. Patients with a higher risk at baseline showed a greater increase in CS over time.

CONCLUSIONS

CS estimates provide important information about dynamic prognostic changes over time for Korean gastric cancer patients, and as such, can be used to guide long-term follow-up strategies.

Laparoscopic stomach-partitioning gastrojejunostomy with reduced-port techniques for unresectable distal gastric cancer

BACKGROUND

The improvement of quality of life is of great importance in managing patients with far-advanced gastric cancer. We report a new cure and less invasive method of creating a stomach-partitioning gastrojejunostomy in reduced-port laparoscopic surgery for unresectable gastric cancers with gastric outlet obstruction.

MATERIALS AND METHODS

A 2.5-cm vertical intraumbilical incision was made, and EZ Access (Hakko Co., Ltd., Tokyo, Japan) was placed. After pneumoperitoneum was created, an additional 5-mm trocar was inserted in the right upper abdomen. A gastrojejunostomy was performed in the form of an antiperistaltic side-to-side anastomosis, in which the jejunal loop was elevated in the antecolic route and anastomosed to the greater curvature of the stomach using an endoscopic linear stapler. The jejunal loop together with the stomach was dissected with additional linear staplers just proximal to the common entry hole so that a functional end-to-end gastrojejunostomy was completed. At the same time, the stomach was partitioned using a linear stapler to leave a 2-cm-wide lumen in the lesser curvature. Subsequently, jejunojejunostomy was performed 30 cm distal to the gastrojejunostomy, and the stomach-partitioning gastrojejunostomy resembling Roux-en Y anastomosis was completed.

RESULTS

All patients resumed oral intake on the day of operation. Neither anastomotic leakage nor anastomotic stricture was observed.

CONCLUSIONS

Our less invasive palliative operation offers the utmost priority to improve quality of life for patients with unresectable gastric cancer.

Benefit of mediastinal and para-aortic lymph-node dissection for advanced gastric cancer with esophageal invasion

BACKGROUND AND OBJECTIVES

Lymph-node dissection in gastric cancers with esophageal invasion (AGCE) is of current interest. This study examined the significance of inferior mediastinal lymph-node (IM) and para-aortic lymph-node (PA) dissection for this type of cancer.

METHOD

Two hundred and seventy cases of AGCE were clinicopathologically reviewed. An index of estimated benefit from lymph-node dissection (IEBLD) was calculated from the frequency of lymph node metastasis in IM and PA, and from 5-year survival rates for metastatic cases.

RESULTS

Among the cases of AGCE, IM and PA metastasis rates were 18.1% and 22.2%, respectively. The IEBLD for IM and PA was similar to that for dissection of the second-tier lymph nodes around the celiac axis. The IM metastasis rate was 0.0% for esophageal invasion of 0-9 mm, 2.2% for 10-19 mm, 17.8% for 20-29 mm, and 21.7% for 30-39 mm of esophageal invasion.

CONCLUSION

AGCE is associated with a high rate of PA metastasis, and with a high rate of IM metastasis when esophageal invasion exceeds 2 cm. Since dissection of IM and PA achieved the same benefit as dissection of second-tier lymph nodes, we recommend thorough dissection of these lymph nodes.

Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

BACKGROUND

Since the early 1990s, pylorus-preserving gastrectomy (PPG) has been used in the treatment of patients with early gastric cancer in order to reduce postprandial symptoms. To date, there have been few reports of long-term symptom evaluation following this procedure. The aim of this study was to evaluate long-term postoperative outcomes after PPG.

METHODS

Three hundred and ninety-seven patients with early gastric cancer were enrolled in this study: 194 patients who underwent PPG and 203 who underwent distal gastrectomy with Billroth-I reconstruction (DGBI). We compared the symptoms for the two groups in a questionnaire on postoperative functional outcomes, endoscopy findings and the appearance of gallstones after surgery.

RESULTS

The incidence of symptoms suggesting early dumping syndrome was significantly lower in the PPG group compared with the DGBI group (P < 0.05). The incidences of disturbed bowel habit and frequent flatus were significantly lower in the PPG than in the DGBI group. The average relative body weight (actual BW/ BW immediately before the surgery) was significantly better in the PPG than in the DGBI group (P < 0.001).

CONCLUSION

The long-term results show that PPG has clear advantages over DGBI in terms of postoperative symptoms and functional outcomes. These results imply that PPG should be the recommended procedure for early gastric cancers located in the middle third of the stomach.

Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years

BACKGROUND

In the majority of gastric surgical units across Japan, Billroth 1 is the preferred method of anastomosis following subtotal distal gastrectomy for gastric cancer. However, across Europe and North America, reconstruction using a Roux-en-Y anastomosis is more common. There is a lack of comparative studies of the two methods focusing on long-term outcome. This study evaluated patient outcome, in terms of adverse gastrointestinal complaints and quality of life, at 5 years following surgery.

METHODS

A total of 652 patients had a subtotal distal gastrectomy for early gastric cancer between January 1993 and December 1999. We studied 229 patients with reconstruction by the Billroth 1 procedure and 214 patients with the Roux-en-Y procedure. All patients had an abdominal ultrasound and endoscopy as part of their follow-up. Quality of life was assessed by questionnaire.

RESULTS

We had an 87% response rate from the questionnaire assessment. The results demonstrated that patients were less likely to experience symptoms of either early or late dumping after Roux-en-Y anastomosis than after Billroth 1. In addition, there were significantly fewer patients with gastritis on endoscopy in the Roux-en-Y group. There was no significant difference in the average relative body weight between the groups. However, patients were more likely to develop gallstones after a Roux-en-Y than after a Billroth 1 reconstruction.

CONCLUSION

The results from this study show that, at 5 years, both symptomatically and functionally, Roux-en-Y reconstruction was superior to the Billroth I method after subtotal distal gastrectomy for gastric cancer. However, the overall outcome in both groups was good, with patient satisfaction scores of around 75% in each group.

Changing patterns of prognosticators during 15-year follow-up of advanced gastric cancer after radical gastrectomy and adjuvant chemotherapy: a 15-year follow-up study at a single korean institute

BACKGROUND

We evaluated the long-term natural history of gastric cancer after radical gastrectomy and adjuvant chemotherapy through a 15-year follow-up study at a single institute.

METHODS

Five hundred patients with advanced gastric adenocarcinoma who received radical gastrectomy and adjuvant chemotherapy were included in this long-term follow-up study. Patients were evaluated by imaging studies and upper gastrointestinal series or endoscopy every 6 months until the 10th year after surgery. Since then, the patients have been followed yearly in the same manner.

RESULTS

The median follow-up period was 190.5 months. The recurrence rate in 5-year survivors was 10.8%. The dominant recurrence pattern was peritoneal carcinomatosis within 5 years and distant metastasis after 5 years post gastrectomy. Tumor stage was a clear-cut prognosticator within 5 years post gastrectomy, but was no longer informative in 5-10 years. At this period, only stage IV (IB-IIIB vs IVM0) was a significantly poor prognosticator. After 10 years, second primary cancer (seven cases) became as important an issue as recurrence of primary gastric cancer (six cases).

CONCLUSIONS

In patients with gastric carcinoma treated with radical gastrectomy and adjuvant chemotherapy, late recurrence after 5 years post gastrectomy was not rare. Prognosticators were varied depending on the length of time after surgery. Tumor factors including stage were prognosticators within 5 years post gastrectomy, but tumor factors except stage IV had no prognostic value after 5 years. In the 5-10 years post gastrectomy, only stage IV (IB-IIIB vs IVM0) was a poor prognosticator. Also, after 10 years, there were no prognosticators.

P53 genetic polymorphism of gastric cancer in Korea

BACKGROUND

Deletion or functional loss of the p53 tumor suppression gene plays a role in oncogenic transformation. The codon 72 polymorphism on exon 4 in the p53 gene produces variant proteins with either arginine (Arg) or proline (Pro), and is associated with an increased susceptibility of cancers of the lung, esophagus, breast, cervix and nasopharynx on a genetic basis. We designed this study to evaluate the influence of the p53 codon 72 polymorphism on gastric cancer in Korea.

METHODS

We extracted the peripheral blood samples in 84 patients with gastric cancer, 66 patients with H. pylori-associated chronic gastritis and 43 controls without H. pylori infection. PCR-RFLP analysis was performed to detect p53 codon 72 polymorphism in these patients.

RESULTS

There was no specific genotype of p53 polymorphism in the gastric cancer group compared to the other groups and no difference in genotypes by histologic subtypes. Classified by tumor location, Pro/Pro genotype was associated with an increase in proximal cancer and Arg/Arg genotype with distal cancer. As the frequency of p53 Arg allele increased, the cancer was of a more poorly differentiated type.

CONCLUSIONS

The specific genotype of p53 polymorphism seems to correlate with tumor location. Increased frequency of p53 Arg allele is associated with more poorly differentiated cancers.

Adjuvant therapy in gastric cancer

Gastric cancer has a poor prognosis. The majority of patients will relapse after definitive surgery, and 5-year survival after surgery remains poor. The role of adjuvant therapy in gastric cancer has been controversial given the lack of significant survival benefit in many randomized studies so far. The results of a large North American study (Gastrointestinal Cancer Intergroup Trial INT 0116) reported that postoperative chemoradiotherapy conferred a survival advantage compared with surgery alone, which has led to the regimen being adopted as a new standard of care. However, controversies still remain regarding surgical technique, the place of more effective and less toxic chemotherapy regimens, and the use of more modern radiation planning techniques to improve treatment delivery and outcome in the adjuvant and neoadjuvant setting. This article reviews the current status of the adjuvant treatment for gastric cancer including discussion on the research directions aimed at optimizing treatment efficacy. Issues such as the identification of patients who are more likely to benefit from adjuvant therapy are also addressed. Further clinical trials are needed to move towards better consensus and standardization of care.

Prognostic value of TP53 codon 72 polymorphism in advanced gastric adenocarcinoma

PURPOSE

A common polymorphism of the tumor suppressor gene TP53 at codon 72 has been associated with human cancer susceptibility. The prognostic role of the polymorphism was assessed in 102 patients with advanced gastric adenocarcinoma.

EXPERIMENTAL DESIGN

We followed up 102 consecutive Caucasian patients with advanced gastric adenocarcinoma for >5 years and determined the status of the TP53 codon 72 polymorphism in DNA samples extracted from archived gastric tissues.

RESULTS

The frequency of the arginine homozygous allele was positively correlated to patient age at baseline (P = 0.002). However, the age-related increase in the percentage of codon 72 arginine p53 was not correlated to the prognosis for gastric cancer patients. Multivariable analysis in patients who had surgery showed that baseline age may be inversely associated with patient survival (odds ratio, 1.1; 95% confidence interval, 1.0-1.2; P = 0.02). Furthermore, alcohol consumption may be associated with reduced survival (P = 0.06).

CONCLUSIONS

These findings indicate that codon 72 arginine p53 may not be associated with a prolonged survival in patients with advanced gastric adenocarcinoma, but further study is needed to assess whether this polymorphism is associated with a late onset or slow progress of early gastric adenocarcinoma.

Novel Operative Technique for Vagal Nerve- and Pyloric Sphincter-preserving Distal Gastrectomy Reconstructed by Interposition of a 5 cm Jejunal J Pouch with a 3 cm Jejunal Conduit for Early Gastric Cancer and Postoperative Quality of Life 5 Years after Operation

The importance of the vagal nerve and pyloric sphincter, the need for pouch reconstruction, and the ideal pouch volume are all matters of controversy. A novel operative technique for vagal nerve- and pyloric sphincter-preserving distal gastrectomy reconstructed by interposition of a 5 cm jejunal J pouch with a 3 cm jejunal conduit was developed as a function-preserving surgical technique to prevent postgastrectomy disorders. The application criteria and technique are outlined in this article. Postoperative quality of life was also investigated clinically. Twenty subjects who underwent this surgical operation (group A: 16 men and 4 women aged 41 to 70 years, mean age 59.5 years) were interviewed to inquire about postoperative gastrointestinal symptoms. These patients were compared with 44 others who underwent conventional distal gastrectomy with D2 lymphadenectomy (group B: 30 men and 14 women aged 43 to 73 years, mean age 62.6 years). Included were patients with early cancer [mucosal or submucosal 1 (SM1) cancer and no lymph node metastasis (N0)] in the middle or lower third of stomach (or both) who were either not eligible for endoscopic excision of gastric mucosa or for partial gastric excision in the mucosa = 3.5 cm or SM1 5.5 cm, or further in distance from the anal margin of the cancer to the pyloric sphincter. Cases in which the remnant stomach would become one-third or less of the original size were also applied. During excision with lymph nodes, the hepatic and celiac branches bifurcating from the anterior and posterior trunks of the vagal nerve were preserved. The antrum was severed 1.5 cm from the pyloric sphincter, preserving the arteria supraduodenalis. The substitute stomach was created as a 5 cm jejunal pouch with a 3 cm jejunal conduit for orthodromic peristaltic movement using an automatic suture instrument to complete a side-to-side anastomosis of the folded jejunum. The anal side of the gastric remnant was manually anastomosed with the jejunal J pouch, and anastomosis of the pyloric antrum with the jejunal conduit was manually completed by stratum anastomosis. Postoperatively, the procedure in group A alleviated gastrointestinal symptoms such as appetite loss, epigastric fullness, reflux esophagitis, early dumping syndrome, body weight loss, endoscopic reflux esophagitis, and endoscopic gastritis in the remnant stomach, postprandial stasis of the substitute stomach, and postgastrectomy cholecystolithiasis better than in group B. The results suggest that the proposed technique is a function-preserving gastric operation appropriate for preventing postgastrectomy disorder.