A Comparative Study of Postoperative Complications Associated with Distal Gastrectomy and Pylorus-Preserving Gastrectomy among Gastric Cancer Patients Based on Nationwide Survey Data and Propensity Score Weighting

Abstract

Simple Summary This study compared postoperative complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data with propensity score weighting (PSW). PPG preserves gastric function but may lead to more complications than DG. Before PSW, 87.8% of DG and 87.1% of PPG patients had no complications (p = 0.053). Severe complications were more frequent in PPG (6.6%) than in DG (3.8%) (p = 0.039). After PSW, overall and severe complication rates were similar (p = 0.960 and p = 0.574). Anastomotic stricture and leakage rates were higher in PPG (2.9% and 1.7%) than in DG (0.6% and 0.5%) before PSW, but not after (p = 0.999 and 0.123). The PSW-adjusted analysis indicates no significant difference in complication rates between PPG and DG.Abstract Background/Objective. This study aimed to compare complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data and propensity score weighting (PSW). PPG preserves gastric function but may lead to more postoperative complications than DG. Methods and Results. We analyzed 9424 gastric cancer patients who underwent either DG (n = 9183) or PPG (n = 241). PSW balanced variables such as age, sex, TNM stage, comorbidities, ASA score, and surgical approach. Before PSW, 87.8% of DG patients and 87.1% of PPG patients had no complications (p = 0.053). Severe complications (Clavien-Dindo IIIa or higher) were more frequent in PPG (6.6%) than in DG (3.8%) (p = 0.039). After PSW, overall complication rates (p = 0.960) and severe complication rates (p = 0.574) were similar between groups. Incidence rates of anastomotic stricture and leakage were higher in PPG (2.9% and 1.7%) compared to DG (0.6% and 0.5%) (p = 0.001 and 0.036) before PSW, but these differences were not significant after PSW (p = 0.999 and 0.123). Conclusion. The PSW-adjusted analysis indicates no significant difference in overall and severe complication rates between PPG and DG in gastric cancer patients.