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
近端胃切除术
改良近端胃切除术联合双通道重建术是局部晚期 GEJ 腺癌的一种优化治疗方案。
双通道重建术
此图显示近端胃切除术联合双通道重建术。
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.
改良近端胃切除术联合 D2 淋巴结清扫术和双通道重建术
该手术切除贲门、胃底、胃体和远端食管，但保留胃窦。
旁白： 治疗局部进展期胃食管和近端胃部癌变肿瘤，可以采用改良近端胃切除术联合淋巴切除术。
胃部周围的淋巴结分站已经有精确定义。标准 D2 淋巴结切除术中切除以下淋巴结分站：第 1 站贲门右，第 2 站贲门左，第 3 站沿胃小弯，第 4a 站沿胃大弯近端，第 4b 站沿胃大弯远端，第 5 站沿胃右动脉，第 6 站沿胃网膜右动脉，第 7 站沿胃左动脉，第 8 站沿肝总动脉，第 9 站腹腔干，第 10 站脾门，第 11 站沿脾血管，第 12 站沿肝固有动脉和肝胃韧带。
我们改良的手术方案还切除第 110 和第 111 站的下纵隔淋巴结，因为如果肿瘤侵入远端食管，这些淋巴结存在转移风险。
在改良近端胃切除术中，在胃角切迹纵断胃体，保留胃窦，同时切除胃体、胃底、贲门和远端食管。
没有切除第 5 站沿胃右动脉淋巴结和第 6 站沿胃网膜右动脉淋巴结，因为近端胃部和胃食管肿瘤转移至这两个站点的风险较低。
在双通道重建术中，于下胸部建立食管空肠吻合口。自该处起远端 10 至 15 厘米处，构建 Roux 袢与胃窦之间的端侧胃空肠吻合。
如有需要，可将胃固定于右侧膈肌脚，以使胃窦呈水平角度。
随后量取 20 至 25 厘米 Roux 袢，在横结肠系膜下方行端侧空肠-空肠吻合术。
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.