Topic Highlight
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2016; 22(26): 5888-5895
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5888
Function-preserving gastrectomy for gastric cancer in Japan
Eiji Nomura, Kunio Okajima
Eiji Nomura, Department of Gastroenterology and General Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
Kunio Okajima, Emeritus professor of Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
Author contributions: Nomura E performed research and wrote the paper; Okajima K contributed critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eiji Nomura, MD, Department of Gastroenterology and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan. nomura@hachioji-hosp.tokai.ac.jp
Telephone: +81-42-6391111 Fax: +81-42-6391144
Received: March 10, 2016
Peer-review started: March 11, 2016
First decision: April 14, 2016
Revised: April 30, 2016
Accepted: June 2, 2016
Article in press: June 2, 2016
Published online: July 14, 2016
Processing time: 117 Days and 22.6 Hours
Abstract

Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy if curability of the gastric cancer can still be achieved. However, if we preserve a wider residual stomach in function-preserving gastrectomy, we should pay attention to the development of metachronous gastric cancer.

Keywords: Early gastric cancer; Function-preserving gastrectomy; Quality of life; Laparoscopic surgery

Core tip: Current surgical function-preserving gastrectomies include pylorus-preserving gastrectomy, proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection. The procedures that include systemic lymph node dissection and the three elements that preserve function are pylorus-preserving gastrectomy and proximal gastrectomy.