Proximal Gastrectomy: Preserving Stomach Function by Removing Only the Upper Portion
Severance Hospital has demonstrated the safety of gastric cancer treatment techniques in collaboration with cancer centers in the United States and Japan.
On March 4, Kim Hyungil, Professor of Gastrointestinal Surgery at Severance Hospital, announced that, together with research teams from MD Anderson Cancer Center, Mayo Clinic, Memorial Sloan Kettering Cancer Center in the United States, and Keio University Hospital in Japan, they have proven the efficacy of 'proximal gastrectomy,' a procedure that removes only the upper part of the stomach where cancer has developed, thereby preserving stomach function as much as possible.
This study, for which Professor Kim Hyungil participated as the corresponding author, received research funding from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).
The results of the study were published in the latest issue of the SCIE-listed international journal in the field of surgery, Surgical Endoscopy.
Proximal gastrectomy is a surgical procedure that partially removes cancer located in the upper section of the stomach near the esophagus. It is mainly used for treating early-stage gastric cancer and, after the resection, the remaining lower part of the stomach is reconnected to the esophagus to preserve digestive function as much as possible. Because this procedure results in fewer issues such as weight loss or nutritional problems caused by dietary restrictions, it is considered beneficial in terms of quality of life.
In this study, the most important indicator for confirming the effectiveness of proximal gastrectomy was the patients' satisfaction with function preservation, which was used as an evaluation variable.
While this surgical method is already common in East Asian countries such as Korea and Japan, it is still used only in a limited way in Western countries like the United States, so there have not been enough cases to clinically confirm its effectiveness. One of the main reasons is that whereas early-stage gastric cancer is often detected in East Asia due to active health screenings, in Western countries, gastric cancer is typically diagnosed after it has progressed beyond the upper part of the stomach to the lower sections.
Professor Kim Hyungil, together with Professor Ikoma of MD Anderson Cancer Center, the first author who has been collaborating on international research into proximal gastrectomy since 2000, formed a research group and conducted a study from 2022 to 2024 involving 64 patients at five institutions.
In this study, the team used a patient-reported outcome (PRO) measure developed by MD Anderson Cancer Center and validated in the United States. Patient-reported outcomes are tools for evaluating treatment effectiveness from the patient's perspective, with patients directly reporting their subjective experiences such as pain, fatigue, and appetite, as well as quality of life.
Professor Kim Hyungil's research team compared the PROs of patients who underwent proximal gastrectomy with those who had total gastrectomy, in which the entire stomach is removed. Three months after surgery, there was no statistically significant difference in quality-of-life indicators such as loss of appetite and reflux.
Professor Kim Hyungil and his co-researchers confirmed through these results that proximal gastrectomy is as safe as total gastrectomy and that it yields superior outcomes in terms of symptoms and weight loss.
However, they noted that more case studies are required to draw more definitive conclusions. The data collected in this study will serve as a basis for preparing large-scale prospective research.
Professor Kim Hyungil stated, "This study marks the first step in evaluating patient satisfaction and effectiveness of proximal gastrectomy in collaboration with world-class cancer centers," adding, "We hope that proximal gastrectomy will be applied to suitable patients in Western countries such as the United States as well, thereby further improving patient satisfaction with gastric cancer treatment."
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