Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Updated Review of Proximal Gastrectomy for Gastric Cancer or Cancer of the Gastroesophageal Junction

  • Tomoyuki Irino (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake) ;
  • Manabu Ohashi (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake) ;
  • Masaru Hayami (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake) ;
  • Rie Makuuchi (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake) ;
  • Motonari Ri (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake) ;
  • Takeshi Sano (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake) ;
  • Toshiharu Yamaguchi (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake) ;
  • Souya Nunobe (Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake)
  • Received : 2024.10.16
  • Accepted : 2024.12.18
  • Published : 2025.01.01
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Abstract

Proximal gastrectomy (PG) has reemerged as a viable surgical option for managing proximal gastric cancer and gastroesophageal junction cancer, particularly for early-stage tumors, offering potential advantages over total gastrectomy (TG). This review examines the evolution of PG, emphasizing surgical techniques and outcomes. Although PG was initially abandoned due to postoperative complications such as reflux esophagitis, advances in reconstruction methods, such as the double-flap technique and double-tract reconstruction, have significantly improved patient quality of life and reduced complications. Modern techniques focus on preserving gastric function, enhancing postoperative nutritional status, and minimizing morbidity, especially compared to TG. However, debates persist regarding the optimal extent of lymphadenectomy, oncological safety, and the risk of metachronous gastric cancer after surgery. Various international guidelines support PG for specific cases, particularly where lymph node involvement is limited, and functional preservation is prioritized. Despite promising survival and quality-of-life outcomes, certain risks, such as anastomotic stenosis and metachronous cancer, remain. The role of PG in treating cancer of the gastroesophageal junction continues to be investigated, with ongoing studies further clarifying its effectiveness. The evolving techniques and increased focus on patient-centered outcomes suggest a renewed role of PG in the surgical management of gastric cancer.

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References

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