Current status of function-preserving surgery for gastric cancer

Area of Science:

• Surgical Oncology
• Gastroenterology

Background:

• Advances in diagnostics enable early gastric cancer (GC) detection.
• Early GC has low metastasis rates, making function-preserving surgery feasible.
• Function-preserving surgery aims to improve postoperative quality of life.

Purpose of the Study:

• To review function-preserving surgical options for early gastric cancer.
• To compare pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG).
• To highlight oncologic safety, potential complications, and reconstruction considerations.

Main Methods:

• Review of retrospective studies on PPG and PG.
• Analysis of reported advantages and disadvantages of each procedure.
• Discussion of reconstruction techniques and remnant gastric cancer risk.

Main Results:

• PPG may reduce dumping syndrome and bile reflux but can cause delayed gastric emptying.
• PG may decrease duodenogastric reflux but carries risks of heartburn and gastric fullness.
• Remnant gastric cancer is a concern after PG, necessitating specific reconstruction methods.

Conclusions:

• Both PPG and PG appear oncologically safe for carefully selected early GC patients.
• Reconstruction methods are crucial for mitigating complications and enabling surveillance.
• Further prospective randomized trials are needed to establish function-preserving surgery as standard care.