Partial Stomach Removal Approach Matches Total Gastrectomy in Safety, Study Finds

A new study challenges conventional approaches to gastric cancer surgery, finding that removing only the upper portion of the stomach where cancer develops can be as safe as total gastrectomy while potentially improving patients' quality of life.

Severance Hospital at Yonsei University announced on January 6 that Professor Kim Hyung-il of the Department of Gastrointestinal Surgery, working 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, has demonstrated the therapeutic effectiveness of proximal gastrectomy.

Proximal gastrectomy is a surgical procedure that partially removes cancer occurring in the upper part of the stomach adjacent to the esophagus. It is primarily performed for early-stage gastric cancer. Rather than removing the entire stomach, surgeons excise only the upper portion and reconnect the remaining lower stomach to the esophagus, maximizing preservation of digestive function. The procedure helps maintain quality of life for gastric cancer patients by minimizing weight loss and nutritional problems associated with dietary restrictions.

While proximal gastrectomy is already a standard surgical method in Asian countries including Korea and Japan, its use remains limited in Western countries such as the United States, resulting in insufficient surgical cases to confirm clinical effectiveness. This disparity largely stems from the prevalence of health screenings in Asia, where gastric cancer is often detected at early stages, whereas Western patients are frequently diagnosed after the cancer has progressed beyond the upper stomach.

Professor Kim formed a joint research team with Professor Ikoma Naruhiko of MD Anderson Cancer Center, with whom he has collaborated on proximal gastrectomy research since 2000. From 2022 to 2024, the team recruited 64 gastric cancer patients from five institutions. The researchers designated patient satisfaction related to digestive function preservation as the most important indicator for confirming the effectiveness of proximal gastrectomy. They set Patient-Reported Outcomes (PRO)—which allow patients to directly report subjective experiences including pain, fatigue, and appetite, as well as quality of life—as the evaluation variable. PRO is a patient-centered tool for assessing treatment effectiveness, developed and validated by MD Anderson Cancer Center in the United States.

When the research team compared PRO between gastric cancer patients who underwent proximal gastrectomy and those who received total gastrectomy, quality-of-life indicators such as loss of appetite and reflux showed no statistically significant differences between the two groups up to three months after surgery. The findings confirmed that proximal gastrectomy is equivalent to total gastrectomy in terms of safety and relatively superior in quality-of-life measures including symptoms such as pain and fatigue, as well as weight loss.

The research team concluded, "The data collected in this study will serve as a foundation for preparing large-scale prospective research," while noting that "additional case investigations are needed to derive more accurate conclusions."

"This study represents the first step in evaluating patient satisfaction and effectiveness of proximal gastrectomy jointly with world-class cancer centers," Professor Kim said. "We hope that proximal gastrectomy will be applied to suitable patients in Western countries including the United States, further increasing treatment satisfaction among gastric cancer patients."

The study received research funding from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The findings were published in the latest issue of Surgical Endoscopy, an SCIE-indexed international journal in the surgical field.