Current status of function-preserving surgery for gastric cancer

Abstract

Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer (GC) at an early stage. Due to the low incidence of lymph node metastasis and favorable prognosis in early GC, function-preserving surgery which improves postoperative quality of life may be possible. Pylorus-preserving gastrectomy (PPG) is one such function-preserving procedure, which is expected to offer advantages with regards to dumping syndrome, bile reflux gastritis, and the frequency of flatus, although PPG may induce delayed gastric emptying. Proximal gastrectomy (PG) is another function-preserving procedure, which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach, although the incidence of heartburn or gastric fullness associated with this procedure is high. However, these disadvantages may be overcome by the reconstruction method used. The other important problem after PG is remnant GC, which was reported to occur in approximately 5% of patients. Therefore, the reconstruction technique used with PG should facilitate postoperative endoscopic examinations for early detection and treatment of remnant gastric carcinoma. Oncologic safety seems to be assured in both procedures, if the preoperative diagnosis is accurate. Patient selection should be carefully considered. Although many retrospective studies have demonstrated the utility of function-preserving surgery, no consensus on whether to adopt function-preserving surgery as the standard of care has been reached. Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.

Keywords: Gastric cancer, Function preserving surgery, Quality of life, Pylorus preserving surgery, Proximal gastrectomy

Core tip: We reviewed the current status of two function-preserving surgeries for gastric cancer (GC), pylorus-preserving surgery and proximal gastrectomy (PG). Although both procedures appear to be oncologically safe for early GC, issues regarding postoperative quality of life remain, especially with PG. The effect of the reconstruction method after PG on postoperative quality of life was analyzed, including the novel double tract reconstruction method, which is expected to overcome disadvantages associated with esophagogastrostomy and jejunal interposition reconstruction. Although some reports showed a benefit with function-preserving surgery, further randomized trials are needed.