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Pylorus-Preserving Gastrectomy for Gastric Cancer: Current Evidence and Future Directions
Sa-Hong Kim1,2,3, Hyuk-Joon Lee1,2,4
1Department of Surgery Seoul National University Hospital Seoul Republic of Korea.
Annals of Gastroenterological Surgery
|July 24, 2026
Summary
Pylorus-preserving gastrectomy (PPG) offers functional benefits for early gastric cancer. Advances in minimally invasive techniques and imaging enhance its safety and may expand its use to select advanced cases.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Pylorus-preserving gastrectomy (PPG) is a surgical approach for early gastric cancer (EGC).
- It preserves pyloric function by maintaining peri-pyloric tissues, including nerves and vessels.
- Randomized controlled trials (RCTs) support its functional advantages over traditional methods.
Purpose of the Study:
- To review current evidence on PPG for EGC.
- To explore the feasibility of extending PPG indications.
- To discuss advancements enhancing PPG safety and application.
Main Methods:
- Review of randomized controlled trials (RCTs) and clinical evidence.
- Analysis of functional outcomes and oncologic safety.
- Evaluation of technological advancements like augmented imaging (ICG) and robotics.
Main Results:
- PPG demonstrates functional benefits, including lower rates of gallstone formation, bile reflux, and nutritional deficiencies (KLASS-04 trial).
- Minimally invasive techniques and augmented imaging improve PPG safety and feasibility.
- Emerging evidence suggests potential for PPG in carefully selected advanced gastric cancer patients.
Conclusions:
- PPG is a safe and effective function-preserving option for cT1N0M0 EGC.
- Technological advancements are enhancing PPG's safety and expanding its potential applications.
- Further research may support extending PPG to select advanced gastric cancer cases with adjuvant therapy.
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