Hiki Naoki, Higuchi Tadashi, Kumagai Koshi, Okuno Kota, Minoura Hiroyuki, Sato Yumi, Fujita Shohei, Harada Hiroki, Chuman Motohiro, Washio Marie, Sakuraya Mikiko, Niihara Masahiro, Kumamoto Yusuke, Naitoh Takeshi, Yamashita Keishi
Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Department of Nutrition, Kitasato University Hospital, Sagamihara, Japan.
Gastric Cancer. 2025 May;28(3):527-536. doi: 10.1007/s10120-025-01603-z. Epub 2025 Mar 18.
Loss of appetite following gastric cancer surgery, particularly total gastrectomy, significantly impacts patient quality of life due to the removal of the ghrelin-secreting region. We developed appetite-preserving gastrectomy (APG), a modified total gastrectomy that preserves this region.
Ten consecutive patients with esophagogastric junction cancer who were indicated for total gastrectomy and underwent APG between April 2023 and April 2024 were evaluated for early surgical outcomes, appetite, and changes in weight and body composition.
There were no postoperative complications of grade II or higher (Clavien-Dindo classification). Appetite, assessed using the Simplified Nutritional Appetite Questionnaire, showed no significant impairment at 3 months (14.5 points, P = 0.82) and 6 months (15 points, P = 0.44) postoperatively compared with preoperative values. Oral calorie intake was maintained at 3 months (1675 kcal, P = 0.97) and 6 months (1675 kcal, P = 0.22) postoperatively compared with preoperative levels. The patients' body weight decreased by 9.2% at 6 months postoperatively compared with preoperative values, but their lean body mass remained stable. Although a significant decrease in the blood Ghrelin levels was observed postoperatively, 53% and 60.4% of the preoperative levels was maintained at one month and 6 months, respectively.
APG is a safe procedure that preserves the residual stomach as an endocrine organ, maintains ghrelin secretion and appetite, and prevents muscle loss. However, further trials are required to compare the efficacy of APG with total gastrectomy in preventing postoperative appetite loss.
胃癌手术后，尤其是全胃切除术后，由于胃泌素分泌区域被切除，食欲不振会显著影响患者的生活质量。我们开发了保留食欲的胃切除术（APG），这是一种改良的全胃切除术，保留了该区域。
对2023年4月至2024年4月期间连续10例因食管胃交界癌而需行全胃切除术并接受APG的患者进行了早期手术结果、食欲以及体重和身体成分变化的评估。
没有II级或更高等级的术后并发症（Clavien-Dindo分类）。使用简化营养食欲问卷评估的食欲在术后3个月（14.5分，P = 0.82）和6个月（15分，P = 0.44）时与术前值相比无显著损害。术后3个月（1675千卡，P = 0.97）和6个月（1675千卡，P = 0.22）时的口服热量摄入与术前水平相比保持稳定。与术前值相比，患者术后6个月体重下降了9.2%，但瘦体重保持稳定。虽然术后观察到血液胃泌素水平显著下降，但分别在术后1个月和6个月时维持了术前水平的53%和60.4%。
APG是一种安全的手术方法，可将残余胃保留为内分泌器官，维持胃泌素分泌和食欲，并防止肌肉流失。然而，需要进一步试验来比较APG与全胃切除术在预防术后食欲丧失方面的疗效。
