APPETITE-PRESERVING GASTRECTOMY (APG) FOR ESOPHAGOGASTRIC JUNCTION CANCER: PRESERVING THE RESIDUAL STOMACH AS AN ENDOCRINE ORGAN higuchi.tadashi@kitasato-u.ac.jp

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APPETITE-PRESERVING GASTRECTOMY (APG) FOR ESOPHAGOGASTRIC JUNCTION CANCER: PRESERVING THE RESIDUAL STOMACH AS AN ENDOCRINE ORGAN

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Yusuke Kumamoto kumamoto@kitasato-u.ac.jp Kitasato University School of Medicine Department of General-Pediatric Hepato Biliary Pancreatic Surgery Sagamihara Japan

Takeshi Naitoh naitot@med.kitasato-u.ac.jp Kitasato University School of Medicine Department of Lower Gastrointestinal Surgery Sagamihara Japan

Naoki Hiki nhiki@med.kitasato-u.ac.jp Kitasato University School of Medicine Department of Lower Gastrointestinal Surgery Sagamihara Japan

Japan

Poster with Discussion

Loss of appetite after gastric cancer surgery, particularly total gastrectomy, markedly impairs postoperative quality of life due to removal of the ghrelin-secreting region. We developed appetite-preserving gastrectomy (APG), a modified total gastrectomy that preserves this region. This study aimed to evaluate the safety and functional outcomes of APG in patients with esophagogastric junction cancer.

Between April 2023 and March 2025, 19 consecutive patients with esophagogastric junction cancer underwent APG. Early surgical outcomes were assessed in all patients. Midterm outcomes, including appetite, oral intake, body weight, body composition, and plasma ghrelin, were analyzed in 10 patients with sufficient follow-up.

The cohort included 14 men and 5 women with a median age of 76 years (range, 44–89); clinical stage I/II/III/IV: 9/1/7/1. Median operative time was 498 minutes (323–883), and median blood loss was 618 mL (75–1692). No postoperative complications, including anastomotic leakage or pancreatic fistula, occurred (Clavien–Dindo grade ≥ II). In the 10 patients with midterm data, appetite scores (SNAQ) were preserved at 3 months (14.5 points, P = 0.82) and 6 months (15 points, P = 0.44). Body weight decreased by 9.2% at 6 months, but lean body mass remained stable. Ghrelin levels were preserved at 53% and 60.4% of baseline at 1 and 6 months.

APG is a safe procedure that preserves the residual stomach as an endocrine organ, maintains ghrelin secretion and appetite, and prevents muscle loss. Larger comparative trials against conventional total gastrectomy are warranted to confirm its efficacy.