Our Summary

This research paper discusses the evolution and benefits of function-preserving surgeries for gastric cancer, specifically early gastric cancer (EGC). Traditional surgery was often the only option for treating stomach cancer, but these operations didn’t pay much attention to preserving the function of the stomach. However, a type of surgery called pylorus-preserving gastrectomy, initially developed for gastric ulcers in 1967, has proven to be effective for EGC.

As medical advancements reduced the need for operations for gastric ulcers, more focus was placed on EGC. This led to an increased use of pylorus-preserving gastrectomy, with additional alterations being made to the procedure, expanding its applications.

The research also mentions several other function-preserving surgical procedures such as proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection. However, the ultimate function-preserving surgery is endoscopic resection, a less invasive procedure that was developed around the same time.

Currently, the most commonly performed and studied function-preserving surgeries are pylorus-preserving gastrectomy and proximal gastrectomy. The benefits of these surgeries include a reduction in the extent of gastrectomy (removal of part of the stomach), preservation of the pylorus (the stomach’s exit), and preservation of the vagal nerve. These procedures can also often be performed using a laparoscopic approach, making them minimally invasive.

The researchers highlight the importance of reducing the extent of the gastrectomy, as long as the cancer can still be effectively treated. However, they caution that preserving a larger part of the stomach in function-preserving gastrectomy could increase the risk of developing new stomach cancers.

FAQs

  1. What is pylorus-preserving gastrectomy and how is it beneficial for early gastric cancer (EGC)?
  2. What are the other function-preserving surgical procedures mentioned in the research paper?
  3. What is the importance of reducing the extent of the gastrectomy in function-preserving surgeries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about gastrectomy is to discuss with your healthcare provider the possibility of undergoing a function-preserving surgery, such as pylorus-preserving gastrectomy or proximal gastrectomy, if you are diagnosed with early gastric cancer. These surgeries aim to preserve the function of the stomach and may have fewer long-term side effects compared to traditional gastrectomy. It is important to have a thorough discussion with your doctor about the benefits and risks of each type of surgery to determine the best treatment option for you.

Suitable For

Patients who are typically recommended gastrectomy are those with early gastric cancer (EGC) who are suitable candidates for function-preserving surgeries. These surgeries are especially beneficial for patients who have tumors located in the upper part of the stomach or near the esophagogastric junction, as well as those with smaller tumors that have not spread to other organs.

Additionally, patients who are in good overall health and have a low risk of complications from surgery may also be recommended for gastrectomy. It is important for patients to discuss their individual case with their healthcare provider to determine the most appropriate treatment plan for their specific situation.

Timeline

Before gastrectomy:

  • Patient is diagnosed with early gastric cancer
  • Patient undergoes various diagnostic tests such as endoscopy, CT scans, and biopsies
  • Treatment options, including surgery, are discussed with the patient
  • Patient may undergo preoperative counseling and preparation for surgery

After gastrectomy:

  • Patient undergoes the gastrectomy procedure, which may be pylorus-preserving or another function-preserving surgery
  • Recovery period in the hospital, which may involve pain management, monitoring for complications, and starting a liquid diet
  • Patient is discharged from the hospital and continues recovery at home, gradually transitioning to a solid diet
  • Follow-up appointments with the surgical team to monitor recovery and potential complications
  • Long-term follow-up to monitor for recurrence of cancer and evaluate the patient’s overall health and quality of life

Overall, the timeline for a patient before and after gastrectomy involves a series of diagnostic tests, treatment discussions, surgery, recovery, and long-term follow-up to ensure the best possible outcome for the patient.

What to Ask Your Doctor

  1. What are the different types of function-preserving surgeries available for treating gastric cancer, and which one do you recommend for my specific case?
  2. What are the potential benefits and risks of undergoing a function-preserving gastrectomy compared to a traditional gastrectomy?
  3. How will my quality of life be impacted after undergoing a function-preserving gastrectomy?
  4. What is the likelihood of the cancer recurring after undergoing a function-preserving gastrectomy?
  5. How long is the recovery period after a function-preserving gastrectomy, and what can I expect during this time?
  6. Will I need any additional treatments, such as chemotherapy or radiation therapy, after undergoing a function-preserving gastrectomy?
  7. Are there any long-term side effects or complications associated with undergoing a function-preserving gastrectomy?
  8. How often will I need follow-up appointments or monitoring after undergoing a function-preserving gastrectomy?
  9. Are there any dietary or lifestyle changes I should make after undergoing a function-preserving gastrectomy to optimize my recovery and overall health?
  10. Can you provide me with more information about the success rates and outcomes of function-preserving surgeries for gastric cancer in general, and specifically for my individual case?

Reference

Authors: Nomura E, Okajima K. Journal: World J Gastroenterol. 2016 Jul 14;22(26):5888-95. doi: 10.3748/wjg.v22.i26.5888. PMID: 27468183