Kim Jeesun, Lee Hyuk-Joon
Department of Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
J Gastric Cancer. 2025 Jan;25(1):247-260. doi: 10.5230/jgc.2025.25.e7.
Advances in gastric cancer screening have enabled earlier detection, shifting the focus of treatment toward preserving patients' quality of life (QoL). Function-preserving gastrectomy (FPG), including pylorus-preserving gastrectomy, proximal gastrectomy, and sentinel node navigation surgery, represents a paradigm shift in the surgical management of early gastric cancer. These techniques aim to balance oncological safety with the preservation of gastric function, mitigating postgastrectomy syndromes such as dumping syndrome, bile reflux, and nutritional deficiencies. QoL assessment tools, including EORTC QLQ-STO22, KOQUSS-40, and PGSAS-45, have become integral for evaluating patient-reported outcomes, providing insights into physical, emotional, and functional recovery. Although current evidence underscores the benefits of FPG, most studies are limited to East Asia, highlighting the need for multinational trials to validate these findings globally. FPG has demonstrated comparable short- and long-term oncological outcomes to conventional gastrectomy. Enhanced nutritional recovery and reduced gastrointestinal sequelae make FPG increasingly attractive. However, its widespread adoption is challenged by technical complexity, resource intensity, and the need for adequate surgical experience. The integration of advanced technologies, such as robotic surgery and artificial intelligence, coupled with personalized approaches, is expected to further optimize FPG outcomes. This review underscores the critical role of standardized QoL assessments, collaborative research, and technological innovations in advancing FPG as a cornerstone of patient-centered gastric cancer care.
胃癌筛查的进展使得早期发现成为可能,治疗重点转向了保留患者的生活质量(QoL)。保留功能的胃切除术(FPG),包括保留幽门的胃切除术、近端胃切除术和前哨淋巴结导航手术,代表了早期胃癌外科治疗的范式转变。这些技术旨在在肿瘤学安全性与保留胃功能之间取得平衡,减轻诸如倾倒综合征、胆汁反流和营养缺乏等胃切除术后综合征。包括欧洲癌症研究与治疗组织QLQ-STO22、KOQUSS-40和PGSAS-45在内的QoL评估工具已成为评估患者报告结局的重要组成部分,为了解身体、情感和功能恢复情况提供了见解。尽管目前的证据强调了FPG的益处,但大多数研究仅限于东亚地区,这凸显了开展跨国试验以在全球范围内验证这些发现的必要性。FPG已显示出与传统胃切除术相当的短期和长期肿瘤学结局。营养恢复的改善和胃肠道后遗症的减少使FPG越来越有吸引力。然而,其广泛应用受到技术复杂性、资源密集度以及对足够手术经验的需求的挑战。机器人手术和人工智能等先进技术与个性化方法的结合,有望进一步优化FPG的效果。本综述强调了标准化QoL评估、合作研究和技术创新在推进FPG作为以患者为中心的胃癌治疗基石方面的关键作用。