Impact of perioperative Helicobacter pylori eradication therapy on long-term survival after distal gastrectomy for gastric cancer

doi:10.4240/wjgs.124292

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Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Nov 27, 2026; 18(11): 124292
Published online Nov 27, 2026. doi: 10.4240/wjgs.124292

Impact of perioperative Helicobacter pylori eradication therapy on long-term survival after distal gastrectomy for gastric cancer

Rui-Chun Shi, Dan Jin, Dan Su, Xiao-Ting Yang, Xin Wang, Jin-Fang Hao, Zhi-Wei Yang

Rui-Chun Shi, Dan Jin, Dan Su, Xiao-Ting Yang, Xin Wang, Jin-Fang Hao, Department of Gastroenterology, Wuzhong People’s Hospital, Wuzhong 751100, Ningxia Hui Autonomous Region, China

Zhi-Wei Yang, Department of Hematology and Rheumatology, Wuzhong People’s Hospital, Wuzhong 751100, Ningxia Hui Autonomous Region, China

Co-first authors: Rui-Chun Shi and Dan Jin.

Author contributions: Shi RC and Jin D are the co-first authors of this study and have made equal contributions, including study design, data collection and analysis, and manuscript preparation; Su D, Yang XT, Wang X, and Hao JF designed the experiments and conducted clinical data collection, performed postoperative follow-up and recorded the data; Shi RC, Jin D, and Yang ZW collated the data and performed statistical analysis, wrote the original manuscript and revised the paper; all authors read and approved the final manuscript.

AI contribution statement: No AI tools were used in writing, editing, or generating any part of this manuscript, including text, images, and data analysis.

Supported by National Health Capacity Building and Continuing Education Center 2025 Chronic Disease Management Research Project, No. GWJJMB202510025121.

Institutional review board statement: This study was approved by the Ethics Committee of Wuzhong People’s Hospital.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: All data generated or analyzed during this study are included in this published article.

Corresponding author: Zhi-Wei Yang, Department of Hematology and Rheumatology, Wuzhong People’s Hospital, No. 143 Xinmin Road, Litong District, Wuzhong 751100, Ningxia Hui Autonomous Region, China. 13909531360@163.com

Received: June 18, 2026
Revised: July 23, 2026
Accepted: September 18, 2026
Published online: November 27, 2026
Processing time: 146 Days and 19.7 Hours

Abstract

BACKGROUND

Persistent Helicobacter pylori (H. pylori) infection is associated with adverse outcomes after gastrectomy for gastric cancer.

AIM

To evaluate the association of perioperative H. pylori eradication therapy with longterm survival in patients undergoing distal gastrectomy for gastric cancer.

METHODS

This retrospective cohort study involved H. pylori-positive patients who underwent distal gastrectomy with D2 lymphadenectomy for gastric adenocarcinoma at our hospital from January 2016 to January 2021. The patients were divided into a perioperative eradication group and a non-eradication group depending on whether they received a 14-day bismuth-containing quadruple regimen. Key measurements included H. pylori status at 6 months, nutritional/inflammatory parameters at 12 months, remnant gastric lesions at 1 year, adjuvant chemotherapy completion, and long-term oncologic outcomes, including 5-year overall survival (OS) and disease-free survival (DFS).

RESULTS

Among the 271 eligible patients (143 non-eradication and 128 eradication), the eradication success rate was 91.41% in the eradication group. Compared with the non-eradication group, the eradication group was associated with significantly higher 5-year OS (91.41% vs 80.42%, P = 0.010) and 5-year DFS (85.94% vs 72.73%, P = 0.008) and lower rates of metachronous gastric cancer (1.56% vs 7.69%, P = 0.018) and gastric cancer-specific death (6.25% vs 15.38%, P = 0.017). Multivariate Cox regression analysis adjusting for age, sex, pathological tumor-node-metastasis stage, differentiation, and lymphovascular invasion revealed that perioperative eradication remained independently associated with improved OS (hazard ratio = 0.551, P = 0.036) and DFS (hazard ratio = 0.604, P = 0.043).

CONCLUSION

In this retrospective cohort, perioperative H. pylori eradication therapy was independently associated with improved long-term survival and reduced risk of metachronous gastric cancer in patients who underwent distal gastrectomy for gastric cancer.

Keywords: Helicobacter pylori; Gastrectomy; Stomach neoplasms; Perioperative care; Disease-free survival

Core Tip: This retrospective cohort study evaluated whether perioperative Helicobacter pylori (H. pylori) eradication therapy is associated with improved long-term outcomes in H. pylori-positive patients after distal gastrectomy for gastric cancer. Eradication therapy was independently associated with higher 5-year overall survival and disease-free survival, lower metachronous gastric cancer risk, better nutritional recovery, less advanced remnant gastric atrophy, and improved chemotherapy tolerance. These findings suggest that perioperative H. pylori eradication may be a valuable adjunct to comprehensive postoperative management.