Chinese expert consensus on function-preserving grstrectomy for gastric cancer (2021 edition) / 中华胃肠外科杂志

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.

Pylorus-preserving gastrectomy and segmental gastrectomy: discrimination of concepts and surgical procedures / 中华胃肠外科杂志

Both pylorus-preserving gastrectomy (PPG) and segmental gastrectomy (SG) achieve the preservation of gastric cardia and pylorus through the circumferential resection of stomach, while concepts and surgical procedures of these two operations are obviously different. In this sense, transectional gastrectomy includes both PPG and SG. PPG is one of the standard surgical procedure for early gastric cancer (EGC). The extent of lymph node dissection (No.1, 3, 4sb, 4d, 6, 7, 8a, 9) and the retention of infrapyloric vessels, hepatic and pyloric branch of vagal nerve has formed a consensus. Meanwhile, SG is regarded as an investigational treatment according to the Japanese gastric cancer treatment guidelines. It is still controversial and may generate an ethical risk in the clinical practice. This article distinguishes the difference in the concepts and surgical procedures between PPG and SG, assisting a comprehensive evaluation in further research.

Functional evaluation after function-preserving gastrectomy / 中华胃肠外科杂志

With the increase of people's health awareness and the progress of medical diagostic technology in recent years, the diagnosis rate of early gastric cancer is increasing year by year. Although radical surgery has good efficacy, how to maximize the preservation of the normal anatomy and function of the stomach and improve the quality of life of patients in the pursuit of radical surgery has become a more important issue in the treatment of early gastric cancer. Under the condition of ensuring radical lymph node dissection, function-preserving gastrectomy can fully preserve gastric function by reducing the resection extent and preserving the pylorus and the vagus nerve, which has advantage of improving quality of life and has great potential in the treatment of early gastric cancer. However, there is no functional evaluation standard for function-preserving gastrectomy at present. Most of the patients are evaluated by quality of life scale, which is relatively subjective. Even though the evaluation of endoscopy, hematology and other objective means can indicate the benefit degree in quality of life brought by functional reconstruction, the evidence level is limited. Therefore, this paper discusses the research status of function-preserving gastrectomy evaluation, postoperative complications, postoperative nutritional status, auxiliary examination and other items in the evaluation of gastric function, and analyzes the prospects of research direction in this field.

Choice of function-preserving gastrectomy / 中华胃肠外科杂志

As the diagnosis rate of early gastric cancer is increasing annually, the current hot spot in the treatment of early gastric cancer is how to better preserve the anatomical structure and physiological function of the stomach and improve the quality of life of patients after surgery under the premise of tumor eradication. Therefore, function-preserving gastrectomy has been the trend of surgical treatment for early gastric cancer. It is not just a modified gastrectomy, but a better combination of improved surgical techniques and the concept of function-preserving treatment, rather than being limited to traditional surgical treatments. Currently, the routine function-preserving gastrectomy mainly includes pylorus-preserving gastrectomy, proximal gastrectomy and partial gastrectomy combined with endoscopy. In addition, with the deeper understanding of metastasis pattern of gastric cancer and the development and popularization of minimally invasive techniques, laparoscopic and endoscopic cooperative surgery is gradually gaining attention. The application of laparoscopic and endoscopic hybrid surgery combined with sentinel lymph node navigation is anticipated in the treatment of early gastric cancer.

Interpretation of key points of Chinese expert consensus on function-preserving gastrectomy for gastric cancer (2021) / 中华胃肠外科杂志

Gastric cancer is one of the most common malignant tumors in China, and with the popularity of gastroscopy in recent years, the proportion of early gastric cancer is increasing gradually. Through standardized endoscopic and/or surgical treatment, patients with early gastric cancer usually have a favorable prognosis, which will inevitably lead to higher demands for postoperative quality of life. Based on this situation, function-preserving gastrectomy (FPG) has become a focus in the treatment of early gastric cancer for the purpose of improving the quality of life. The "Chinese expert consensus on function-preserving gastrectomy for early gastric cancer (2021)" will guide surgeons to perform standardized FPG, and ensure the maximum quality of life for the patients.

The value and key point of function preserving gastrectomy in early gastric cancer / 中国实用外科杂志

With the detection rate of early gastric cancer increases annually, more and more patients can survive for a long time after surgery. Thus, surgeons have paid more attention to preserve the function of the remnant stomach, limit the surgical trauma and improve the quality of life. Pylorus-preserving gastrectomy andlocal gastrectomy are the most common kind of function preserving gastrectomy. The key points we concern are whether they will bring about the risk of radical tumors, whether they will increase the occurrence of surgical complications and whether they are difficult to popularize. The systematic and in-depth study of the key aspects of these function preserving gastrectomy and the provision of a strong evidence-based medical basis will contribute to a new round of innovation in the surgical treatment of early gastric cancer.

Surgical treatment of early gastric cancer / 中国实用外科杂志

Early gastric cancer is a curable disease.Referring to the Japanese Gastric Cancer Treatment Guidelines, surgeons should choose the low invasive and high quality QOL surgical treatmentfor early gastric cancer on the premise of radical treatment. More evidence-based medical research have proved the safety of endoscopic resection and reduction surgery in the treatment of early gastric cancer. Those methods have become the mainstream treatment today.

Function-Preserving Surgery in Gastric Cancer

The rising incidence of early gastric cancer has enabled the development of function-preserving gastrectomy with the focus on post gastrectomy quality of life and adherence to sound oncologic principles. It is concurrent with the growing popularity of minimally invasive surgery; and both are commonly used together. The different kinds of function-preserving gastrectomy included in this review are: pylorus-preserving and proximal gastrectomy, vagus nerve preservation, sentinel node navigation, and various endoscopic & minimally-invasive techniques. In this article the indications, techniques, oncologic safety, functional benefit, and outcomes of each kind of function-preserving gastrectomy are discussed.