[Chinese expert consensus on function-preserving gastrectomy for gastric cancer(2025 edition)].

Abstract

With the advancement of surgical treatment for gastric cancer surgery, the preservation of gastric function to reduce the post-operative impacts on patients' quality of life, while ensuring effective surgical outcomes, have become both patients' expectations and the pursuit of surgeons. The emergence of the concept of function-preserving gastrectomy (FPG) marks the entry of surgical treatment of gastric cancer into a more personalized and precise era. The "Chinese expert consensus on function - preserving gastrectomy for gastric cancer(2021 edition)" was the first systematic effort to define FPG, outlining its indications and surgical approaches. In recent years, with the rapid development of surgical technologies, such as functional visualization, lymph node tracing, vascular navigation, and multi-omics imaging artificial intelligence (AI), the concept and practice of FPG have continued to evolve. Therefore, led by the 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, and the Gastric Cancer Committee of the Chinese Anticancer Association, a group of experts has come together to update and refine the consensus based on domestic and international literature, as well as recent researches and clinical practice. The definition of FPG remains consistent with the 2021 edition, emphasizing the goal of achieving radical resection for early gastric cancer while minimizing the scope of surgery, selecting appropriate reconstruction methods, and preserving as much gastric function as possible. The main surgical techniques include those that reduce the extent of surgery (such as pylorus-preserving gastrectomy, segmental gastrectomy, local gastric resection, and endoscopic resection), proximal gastrectomy (PG), and distal gastrectomy with vagus nerve preservation. After PG, the surgical reconstruction of the digestive tract involves procedures such as anastomosis between the distal remnant stomach and esophagus, esophagus-tube stomach anastomosis, double tract reconstruction (DTR), interposition jejunostomy, side to side gastroesophagostomy (SOFY), and double flap gastroesophagostomy (Kamikawa anastomosis). In recent years, new anti-reflux techniques have emerged, such as the tube-shaped stomach "Giraffe anastomosis", modified SOFY anastomosis, single flap gastroesophagostomy, arch-shaped anastomosis, and tunnel anastomosis. Functional assessment after FPG primarily includes evaluating remnant gastric function, function-related complications, post-operative nutritional status, and quality of life. This updated consensus is expected to standardize the practice of FPG, provide more personalized surgical treatment options for patients with gastric cancer, and further improve their post-operative quality of life.