Surgery

Aug. 22, 2025

A recent study from Mayo Clinic introduces a refined surgical option for patients with locally advanced gastroesophageal junction (GEJ) adenocarcinoma. The procedure modified proximal gastrectomy (PG) with double tract reconstruction (DTR) and D2 lymphadenectomy to preserve the gastric antrum, which is the lowermost portion of the stomach. This approach may support better postoperative nutrition and quality of life while maintaining oncologic safety.

A shift in gastric cancer patterns

"Stomach cancer patterns are changing in the U.S. and Western Europe. More cancers are now found in the upper part of the stomach, near the esophagus," says Travis E. Grotz, M.D., M.S., senior author and surgical oncologist at Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota.

Traditionally, these tumors have been treated with total gastrectomy, which removes the entire stomach. While effective for cancer control, total gastrectomy is associated with long-term complications such as weight loss, anemia and vitamin deficiencies.

Innovative approach combines margin clearance with organ preservation

Published in Cancers in 2025, the study evaluated PG with DTR as an alternative to total gastrectomy for select patients with upper stomach cancers. According to Dr. Grotz, this organ-preserving method, commonly used in Asia for early-stage diseases, was adapted for Western patients with more-advanced tumors.

The modified PG technique removes the upper portion of the stomach and part of the esophagus, preserving the antrum to aid digestion and nutrient absorption.

"This approach allows for adequate margin clearance and lymphadenectomy while preserving the antrum," says Dr. Grotz.

Technique shows favorable postoperative metrics

In a cohort of 14 patients undergoing PG with DTR:

• R0 resection, which is complete tumor removal with no cancer cells at the margins, was achieved in 100% of cases.
• No locoregional recurrence was observed at 18 months.
• At 12 months, patients exhibited less weight loss compared with those who underwent total gastrectomy, signifying a nutrient absorptive advantage.
• Hemoglobin levels were higher postoperatively in patients who had PG with DTR, suggesting better iron absorption.

Patients also experienced fewer complications, with no anastomotic leaks and a lower rate of severe reflux esophagitis compared with historical PG technique.

Evolving surgical care to prioritize function and patient-centered outcomes

This study supports PG with DTR as a viable alternative to total gastrectomy for patients with tumors involving 5 cm or less of the upper stomach and 2 cm or less of the lower esophagus. The technique offers oncologic safety while preserving digestive function and nutritional status.

Modified PG, while less extensive, achieved complete tumor removal and showed no recurrence within the immediate area or region surrounding the original tumor site at 18 months. Patients also experienced better weight maintenance and improved hemoglobin levels, suggesting nutritional advantages. However, larger studies with extended follow-up are necessary to validate these findings.

"This study demonstrates that we can offer a less invasive option without compromising cancer outcomes," said Emily L. Siegler, first author and surgical resident at Mayo Clinic. "It's a step toward more personalized, function-preserving care for patients with upper gastric cancers."

For more information

Siegler E, et al. Modified proximal gastrectomy and D2 lymphadenectomy is an oncologically sound operation for locally advanced proximal and GEJ adenocarcinoma. Cancers. 2025;17:2455.

Refer a patient to Mayo Clinic.