Pylorus Preserving Gastrectomy (PPG) with Lymph Node Dissection for Early Gastric Cancer in the Middle Third of the Stomach

We carried out pylorus preserving gastrectomy (PPG) on sixteen patients with early gastric cancer in the middle third of the stomach. PPG is used to prevent dumping syndrome and to protect against secondary carcinogenesis due to bile juice reflex. The oral resection line was the same as in subtotal gastrectomy and the anal resection line was 1.5 centimeter to the oral side of the pyloric ring. We carried out R1 or R1+No.7 lymph node dissection when cancer invasion was limited to the mucosa, and R2 lymph node dissection when cancer invasion was limited to the submucosa. We preserved the pyloric artery to maintain blood flow in the pylorus.