Chinese expert consensus on function-preserving gastrectomy for gastric cancer (2021 edition)

Abstract

With the development of surgical treatment for gastric cancer, under the premise of ensuring the effect of surgical treatment, the objectives of preserving the function of stomach, diminishing the influence of quality of life and keeping the outcome of treatment, are the expectation of patients and the goal of surgeons. The emerge of function-preserving gastrectomy (FPG) indicates that the surgical treatment of gastric cancer steps into the individualized and precision era. Because the concept and operation procedures of FPG have not achieved consensus, the Gastrointestinal Surgery Branch, Surgery Branch, Chinese Medical Association (CMA) with Chinese Society of Surgical Oncology of Chinese Medical Doctor Association(CMDA), Chinese Society of Upper Gastrointestinal Surgeon of CMDA, Stomach and Intestines Committee of Chinese Anticancer Association, convenes some experts to summarize the recent literatures and discuss to reach the consensus about the FPG in the treatment of early gastric cancer. The definition of FPG is as follows: without compromising the oncological efficacy of early gastric cancer, decrease of the operational scale, selection of optimal reconstruction procedures and preservation of the gastric function as much as possible. The most common operation methods are procedures of minimized scale (pylorus-preserving gastrectomy, segmental gastrectomy, local gastrectomy and endoscopic resection) and proximal gastrectomy (PG). Besides the anastomosis of esophagus and gastric remnants, the reconstruction method after proximal gastrectomy also includes tubular gastroesophagostomy, double tract reconstruction, Interposition jejunostomy, side to side gastroesophagostomy (SOFY), double flap gastroesophagostomy (Kamikawa anastomosis), etc. The evaluation of gastric function after FPG includes the assessment of gastric remnant function, the functional complications and the nutritional status. We believe the publication of consensus will properly popularize FPG, promote further research about the gastric cancer and function of gastric remnant, and improve the theoretical study about FPG. Moreover, the indications and procedures of FPG will be broadened and renovated.