Controversies and consensus surrounding laparoscopic pylorus-preserving gastrectomy for early gastric cancer

In recent years, the detection rate of early gastric cancer in China has significantly increased. Early gastric cancer is associated with a favourable prognosis; thus, enhancing the postoperative quality of life for patients has become an increasingly pressing issue in treating gastric cancer. Consequently, function-preserving gastrectomy has emerged as a viable option. This surgical approach aims to minimize the extent of resection while preserving some gastric function, all within the framework of radical tumour excision. Pylorus-preserving gastrectomy (PPG) serves as a representative example of a function-preserving technique and is particularly suitable for early-stage gastric cancer of the middle segment of the stomach. Compared with distal gastrectomy, laparoscopic PPG offers several advantages: (1) Results in less surgical trauma; and (2) Reduces the incidence of postoperative complications such as dumping syndrome, bile reflux gastritis, and gallstones while also improving nutritional status postsurgery. However, the implementation of PPG remains contentious within the medical community. In light of new Japanese guidelines for gastric cancer treatment and informed by current research trends along with relevant evidence-based medicine principles, this review examines various aspects related to laparoscopic PPG, including its definition and indications, safety profile, benefits, technical considerations, methods for digestive tract reconstruction and postoperative complications.