J Korean Med Assoc.  2024 Sep;67(9):595-600. 10.5124/jkma.2024.67.9.595.

Function-preserving gastrectomy in gastric cancer

• Park DJ

• KMID: 2559649
• DOI: http://doi.org/10.5124/jkma.2024.67.9.595

Abstract

Background
This study aimed to provide an overview of minimally invasive and function-preserving surgeries for gastric cancer, focusing on the latest developments in proximal gastrectomy.
Current Concepts
Laparoscopic and robotic surgeries have increasingly been adopted as minimally invasive techniques, and pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG) have increasingly been performed as function-preserving surgeries. PPG reduces the incidence of dumping syndrome, bile reflux, and gallstones. After PG, there is a high possibility that vitamin B12 injections are not needed. In addition, compared with total gastrectomy, it has the advantages of less anemia, better nutritional status, and secretion of various gastrointestinal hormones. Double-tract reconstruction (DTR) is often performed in PG to prevent reflux esophagitis. In the Korean Laparoendoscopic Gastrointestinal Surgery Study 05 trial, patients who underwent laparoscopic PG with DTR required less vitamin B12 supplementation than those who underwent total gastrectomy, and there was no difference in complication and survival rates. In addition, quality of life, such as physical and social functions, was better.
Discussion and Conclusion
PG with DTR can be recognized as function-preserving gastric cancer surgery for patients with upper early gastric cancer. Minimally invasive surgeries such as laparoscopic and robotic procedures have become more common. Function-preserving surgeries now include PPG and PG. Among these, the DTR technique is frequently performed after PG, offering the advantages of preserving vitamin B12 levels and improving the quality of life.

Keyword

Stomach neoplasm; Gastrectomy; Quality of life; 위신생물; 위절제술; 삶의 질