Stomach-Preserving Surgery May Improve Early Gastric Cancer Outcomes

Long-term quality of life was associated with stomach-preserving surgery for patients with early-stage gastric cancers, researchers found.

Stomach-preserving surgery may improve outcomes and quality of life over standard gastrectomy (surgical removal of the stomach) in patients with early-stage gastric cancer, according to an analysis of the SENORITA clinical trial.

The goal of the SENORITA trial was to compare long-term quality of life and nutritional outcomes in patients with early-stage gastric cancer who underwent either stomach-preserving surgery (194 patients) or standard gastrectomy (257 patients). All patients underwent a sentinel node biopsy, which is the surgical removal of lymph nodes to determine if the cancer has spread.

“In radical gastrectomy for early gastric cancer, more than 60% of the stomach is resected and systematic lymph node dissection is performed even if the tumor is small,” the researchers wrote in their study, which was published in JAMA Surgery. “Radical gastrectomy achieves oncological curability; however, patients experience various types of post gastrectomy syndrome and their quality of life deteriorates after surgery.”

Quality of Life After Surgery

Findings showed that at three months after surgery, the group that underwent stomach-preserving surgery tended to have better quality-of-life outcomes regarding physical functioning; difficulty breathing (dyspnea); appetite loss; difficulty swallowing (dysphagia); eating restriction; anxiety; taste change; and body image.

The researchers also found that there were patient factors associated with improved quality of life in the stomach-preserving group. Patients who had tumors located in the greater curvature of the stomach tended to have a better global health status and fewer eating restrictions three months after surgery. Conversely, having tumors located in the middle or upper third of the stomach was associated with a higher risk of eating restrictions.

Additionally, segmental resection (surgical removal of part of the stomach, while maintaining the cardia and pylorus) was associated with a higher risk of diarrhea and eating restrictions three years after surgery.

“Therefore, sentinel navigation surgery is a better option for patients with small tumors located in the greater curvature of the stomach,” the researchers wrote.

According to the National Institutes of Health, sentinel navigation surgery is a type of surgery that limits lymph node dissection. It preserves the majority of the stomach volume and avoids nerve damage.

Long-Term Nutritional Outcomes

Regarding nutritional outcomes, patients in the stomach-preserving group also had better outcomes one year after surgery. They tended to have higher body mass index (BMI), hemoglobin (a protein in the red blood cells), albumin (a protein in the blood plasma) and total protein.

“BMI, hemoglobin level and total protein level of patients in the stomach-preserving group recovered to levels almost similar to the preoperative values,” the researchers wrote. “In contrast, the standard group had consistently reduced BMI, hemoglobin levels and total protein levels until three years postoperatively.”

Ultimately, the researchers concluded that these findings may help guide treatment decisions in patients with early-stage stomach cancer.

“Stomach-preserving surgery after sentinel node evaluation was associated with better long-term [quality of life] and nutritional outcomes than standard gastrectomy,” the authors wrote. “These findings may help facilitate decision-making regarding treatment for patients with early-stage gastric cancer.”

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