Function-preserving gastrectomy for gastric cancer in Japan

Area of Science:

• Surgical Oncology
• Gastroenterology

Background:

• Historically, radical surgery was the primary gastric cancer treatment, with less focus on function preservation.
• The development of early gastric cancer (EGC) definitions and advancements in surgical techniques led to modified procedures.
• The advent of H2-blockers reduced gastroduodenal ulcer surgeries, increasing the focus on EGC and expanding indications for function-preserving surgeries like pylorus-preserving gastrectomy.

Purpose of the Study:

• To review the evolution and current status of function-preserving gastrectomies in gastric cancer treatment.
• To highlight the key elements and importance of reducing the extent of gastrectomy.
• To discuss the role of minimally invasive approaches and potential risks like metachronous gastric cancer.

Main Methods:

• Review of historical surgical developments and current practices in gastric cancer surgery.
• Analysis of function-preserving gastrectomies, including pylorus-preserving gastrectomy and proximal gastrectomy.
• Discussion of the critical elements: reduced extent of resection, pylorus preservation, and vagal nerve preservation.

Main Results:

• Pylorus-preserving gastrectomy and proximal gastrectomy are current standards, often performed laparoscopically.
• These techniques emphasize reduced resection extent, pylorus preservation, and vagal nerve preservation for better outcomes.
• Endoscopic resection is considered the ultimate function-preserving approach currently available.

Conclusions:

• Reducing the extent of gastrectomy is paramount in function-preserving surgery for gastric cancer, provided curability is maintained.
• Minimally invasive techniques and preservation of key anatomical structures are crucial.
• Careful monitoring for metachronous gastric cancer is necessary when wider residual stomach is preserved.