Abstract and Introduction
Abstract
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.
Introduction
For patients with localized but non-early (T2 or higher) upper third gastric cancer (GC) and gastroesophageal junction (GEJ) cancer with limited esophageal extension, total gastrectomy (TG) with D2 lymph node (LN) dissection is considered the standard surgical treatment.[1,2] However, 5–50% of patients who undergo TG experience post-gastrectomy syndrome, which consists of dumping syndrome due to lack of food reservoir, weight loss due to impaired appetite and oral intake, and anemia due to intrinsic factor loss and vitamin B12 malabsorption.[3] Proximal gastrectomy (PG) can theoretically mitigate these problems by preserving stomach functions such as the food reservoir and gastric endocrine function.[4–6] However, PG has been known to be associated with high incidence of postoperative reflux esophagitis (20–65%) and impaired quality of life (QOL).[7–10] For these reasons, PG is not commonly performed in Western countries.
In East Asia, surgeons developed novel reconstruction techniques to prevent post-PG reflux esophagitis, such as double-tract reconstruction and the double-flap technique,[11–16] and PG has been commonly performed for early (clinical T1N0) upper third GC in recent years.[1,2] However, there is still no global consensus on the oncologic and nutritional benefits of PG compared with TG, and the optimal anti-reflux reconstruction technique after PG remains unknown.
In the present article, we review 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.
Chin Clin Oncol. 2022;11(5):39 © 2022 AME Publishing Company
