J.Jpn. Surg. Soc.. 126(3): 233-239, 2025

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Feature topic

SELECTION OF OPERATIVE PROCEDURE FOR PREVENTING POSTGASTRECTOMY SYMPTOMS

Surgical treatment remains the only way to cure advanced gastric cancer. However, certain postgastrectomy syndromes （PGS） are inevitable after surgery for gastric cancer. PGS include functional and organic disorders. Functional disorders are defined to a greater or lesser extent by the type of gastrectomy and reconstruction methods, whereas organic disorders can be avoided to a certain extent by surgical ingenuity. Function-preserving gastrectomy includes pylorus-preserving gastrectomy, subtotal gastrectomy, and proximal gastrectomy but its application in advanced gastric cancer should be performed with caution. Furthermore, there are postoperative complications specific to these surgical procedures, so it is necessary to take sufficient precautions to prevent those complications. In some centers, surgery to create a gastric substitute using a jejunal pouch has been introduced to preserve digestive function, but there is no clear evidence of its usefulness in preventing postoperative weight loss or improving quality of life based on the results of prospective, randomized, controlled trials. At present, there is no method that can prevent PGS in advanced gastric cancer, but there is potential to reduce postoperative disability through various surgical techniques. Further research, including methods for assessing postoperative disorders, is expected to be developed in the future.

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