Function-preserving gastrectomy for early gastric cancer based on Japanese researches

Abstract

In the past, people only focused on surgical resection of gastric cancer to obtain satisfactory therapeutic effect, while the concept of function-preserving in gastric cancer surgery has not been emphasized. Gastric function-preserving surgery was originally performed by Japanese doctor Maki for surgical treatment of gastroduodenal ulcer. With the definition of early gastric cancer being accepted, the pylorus-preserving gastrectomy can be used continuously in the treatment of gastric cancer. Because of high incidence of early gastric cancer in Japan, a variety of application and research about function-preserving gastrectomy in other areas for treatment of early gastric cancer, such as proximal gastrectomy and jejunal interposition, segmental gastrectomy, gastric local resection and laparoscopic and endoscopic cooperative surgery (LECS) at the same time, and regional or sentinel lymph node dissection were performed for the purpose of radical cure. Function-preserving gastrectomy for the treatment of early gastric cancer should include four important factors: (1) decrease of the scope of gastrectomy; (2)retaining pylorus; (3)retaining vagus nerve; (4)regional or sentinel lymph node dissection. The technique of sentinel lymph node can reduce the extent of gastric resection, avoid distal gastrectomy or total gastrectomy, and make gastric resection more suitable for laparoscopic partial gastrectomy, segmental resection, pylorus-preserving gastrectomy and proximal gastrectomy. Function-preserving gastrectomy has the advantage of improving the quality of life and has great potential in the treatment of early gastric cancer. However, the various treatment methods including LECS need strict technical standardization for confirmation of oncology safety. We need careful design, prospective multicenter randomized controlled trials to provide theoretical and technical support.