The role of proximal gastrectomy in gastric cancer

Over the past 30 years, the prevalence of upper third gastric cancer (GC) and gastroesophageal junction (GEJ) cancer has increased. Total gastrectomy with D2 lymph node dissection is the standard surgical treatment for non-early (T2 or higher) upper third and GEJ cancers, but total gastrectomy often results in post-gastrectomy syndrome (5-50%), consisting of weight loss, dumping syndrome, and anemia. Proximal gastrectomy (PG) has the potential to avoid these postoperative problems by preserving stomach function. However, PG has historically been discouraged by surgeons owing to the high incidence of postoperative reflux esophagitis (20-65%), anastomotic stenosis, and decreased quality of life. In recent years, anti-reflux reconstruction techniques, such as the double flap technique and double-tract reconstruction, have been developed to be performed after PG, and evidence has emerged that these techniques not only reduce the incidence of postoperative reflux esophagitis but also decrease postoperative weight loss and prevent anemia. Prospective studies are underway to determine whether PG with anti-reflux techniques improves patient-reported quality of life. In the present work, we reviewed available evidence for the use of PG for GC and GEJ cancer, including oncologically appropriate patient selection for PG, potential functional benefits of PG over TG, and various types of reconstructions that can be performed after PG, as well as future research on the use of PG.