Pylorus-preserving gastrectomy enhances long-term bone health in older adults after gastrectomy.

Authors

Atsushi Morito, Tomoyuki Irino, Masayoshi Terayama, Motonari Ri, Rie Makuuchi, Masaru Hayami, Manabu Ohashi, Souya Nunobe

Published in

Surgical endoscopy. Jul 01, 2026. Epub Jul 01, 2026.

Abstract

Gastrectomy for gastric cancer (GC) can impair gastrointestinal function, leading to malabsorption, bone loss, and vertebral fractures (VFs), especially in older adults. Pylorus-preserving gastrectomy (PPG) may attenuate these metabolic complications. This study compared long-term bone outcomes after laparoscopic distal gastrectomy with Billroth-I reconstruction (LDGBI) versus laparoscopic PPG (LPPG).
We retrospectively analyzed 75 patients aged ≥75 years with clinical T1N0M0 GC who underwent LDGBI (n = 50) or LPPG (n = 25) between 2005 and 2019. Bone mineral density (BMD) was measured using CT-based Hounsfield units at L1, and VFs were evaluated 1, 3, and 5 years postoperatively. Analysis of covariance and logistic regression were performed.
BMD loss was significantly greater after LDGBI at 3 years (10 vs. 5 HU, P = 0.038) and 5 years (16 vs. 6 HU, P = 0.036). VF incidence was higher in the LDGBI group at 3 years (14.0% vs. 0%, P = 0.014) and 5 years (28.0% vs. 8.0%, P = 0.034). LDGBI was independently associated with greater 5-year BMD reduction (coefficient 7.83, 95% CI 0.22-15.44, P = 0.044). Logistic regression showed no significant association with VFs (OR 3.57, 95% CI 0.71-17.88, P = 0.12).
LPPG was associated with reduced long-term BMD loss in older GC patients and may better preserve postoperative bone health.

PMID:
42384195
Bibliographic data and abstract were imported from PubMed on 01 Jul 2026.

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