Appetite-preserving gastrectomy (APG) for esophagogastric junction cancer: preserving the residual stomach as an endocrine organ.

IF 6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastric Cancer Pub Date : 2025-05-01 Epub Date: 2025-03-18 DOI:10.1007/s10120-025-01603-z

Naoki Hiki, Tadashi Higuchi, Koshi Kumagai, Kota Okuno, Hiroyuki Minoura, Yumi Sato, Shohei Fujita, Hiroki Harada, Motohiro Chuman, Marie Washio, Mikiko Sakuraya, Masahiro Niihara, Yusuke Kumamoto, Takeshi Naitoh, Keishi Yamashita

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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保胃口胃切除术治疗食管胃结癌：保留残胃作为内分泌器官。

背景：胃癌手术，特别是全胃切除术后食欲下降，由于胃促生长素分泌区被切除，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），一种改良的全胃切除术，保留了这一区域。方法：在2023年4月至2024年4月期间，连续10例食管胃结癌患者接受全胃切除术并行APG，评估早期手术结果、食欲、体重和身体组成的变化。结果：术后无II级及以上并发症（Clavien-Dindo分级）。使用简化营养食欲问卷评估食欲，与术前相比，术后3个月（14.5分，P = 0.82）和6个月（15分，P = 0.44）的食欲没有明显下降。与术前相比，术后3个月（1675 kcal, P = 0.97）和6个月（1675 kcal, P = 0.22）的口服热量摄入维持在术前水平。术后6个月患者体重较术前下降9.2%，但瘦体质量保持稳定。尽管术后血液Ghrelin水平明显下降，但在1个月和6个月时分别维持术前水平的53%和60.4%。结论：APG是一种安全的手术，可保留残胃作为内分泌器官，维持胃饥饿素分泌和食欲，防止肌肉损失。然而，需要进一步的试验来比较APG与全胃切除术在预防术后食欲下降方面的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastric Cancer 医学-胃肠肝病学

CiteScore

14.70

自引率

2.70%

发文量

审稿时长

6-12 weeks

期刊介绍： Gastric Cancer is an esteemed global forum that focuses on various aspects of gastric cancer research, treatment, and biology worldwide. The journal promotes a diverse range of content, including original articles, case reports, short communications, and technical notes. It also welcomes Letters to the Editor discussing published articles or sharing viewpoints on gastric cancer topics. Review articles are predominantly sought after by the Editor, ensuring comprehensive coverage of the field. With a dedicated and knowledgeable editorial team, the journal is committed to providing exceptional support and ensuring high levels of author satisfaction. In fact, over 90% of published authors have expressed their intent to publish again in our esteemed journal.