Function-preserving surgery for gastric cancer: current status and future perspectives

Abstract

The number of early gastric cancer (EGC) cases has been increasing because of improved diagnostic procedures including endoscopy and screening systems. Therefore, function-preserving gastrectomy (FPG) for EGC with the expectation of better quality of life (QOL) after surgery may be increasingly utilized, due to its association with low rate of lymph node metastasis and excellent survival and the possibility of employing less invasive procedures such as laparoscopic gastrectomy in combination. Pylorus-preserving gastrectomy (PPG) with curative intent lymph node dissection is a representative FPG that has been used in EGC, and its superiorities, indications, limitations, and survival benefits have already been reported in several retrospective studies. Laparoscopic proximal gastrectomy (LAPG) has also been employed in EGC of the upper third of the stomach; however, LAPG was found to be associated with major issues in achieving a balance between swallowing and reflux prevention. In patients with EGC in the upper third of the stomach, laparoscopy-assisted subtotal gastrectomy with a preserved, albeit very small, stomach may provide a better QOL and fewer postoperative complications. FPG is recommended as a surgical treatment for EGC if the indication is accurately diagnosed and strictly confirmed; however, these techniques in laparoscopic surgery present technical difficulties to surgeons without a certain degree of skills. Although many retrospective studies revealed the functional benefits or oncological safety with FPG, further prospective studies using large case series are necessary to reveal the value of FPG compared with the conventional procedures.

Clinicopathologic characteristics in patients with upper third gastric cancer following radical surgical treatment

“…Local recurrence and distant metastasis are the other most important factors that affect postoperative OS of UTGC. [ 26 ] In spite of the significant effect of enlarged lymph node dissection and joint viscera resection for gastric cancer, the overall effect is still unsatisfactory. More than half of the patients relapse after radical gastrectomy, which is the main cause of death after radical gastrectomy.…”

Potential for local resection with sentinel node basin dissection for early gastric cancer based on the distribution of primary sites

“…Faster improvement in postoperative gastric function is expected after function-preserving gastrectomy, such as partial gastrectomy, segmental gastrectomy, and proximal gastrectomy with reduced LN dissection [5][6][7][8]. We believe that the sentinel node (SN) concept is an attractive option for the provision of function-preserving surgery in EGC patients.…”

Function-Preserving Surgery in Gastric Cancer

“…26 Remnant gastric cancer is higher after open PG (3.6~9.1%) than after open DG (0.4~2.5%). 2 Endoscopic surveillance after surgery is an important tool for detection of recurrence. Although intubation of the endoscope can be difficult in PG with an esophagojejunostomy (EJ) reconstruction, especially with a greater than 10 cm interposed jejunal length.…”

“…With this technique, the physiological gastric emptying is theoretically maintained; hence, alkaline reflux, dumping syndrome, disturbed bowel habits, and weight loss may be reduced in contrast to the standard distal gastrectomy (DG) with Billroth I reconstruction. 2 According to the Japanese gastric cancer treatment guidelines, 3 PPG can be considered for the treatment of clinical T1 N0 M0 gastric cancers in the middle portion of the stomach with distal tumor border at least 4 cm proximal to the pylorus.…”

“…14 Anastomosis is done using intracorporeal delta-shaped anastomosis and a combination of stapler & handsewn procedures. 2 Confirming the tumor location by use of pre-operative placement of marking clips and intraoperative gastroscopy has ensured the oncologic safety of this procedure.…”