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. 2025 May;28(3):527-536.
doi: 10.1007/s10120-025-01603-z. Epub 2025 Mar 18.

Appetite-preserving gastrectomy (APG) for esophagogastric junction cancer: preserving the residual stomach as an endocrine organ

Naoki Hiki #  1 , Tadashi Higuchi #  2 , Koshi Kumagai  2 , Kota Okuno  2 , Hiroyuki Minoura  2 , Yumi Sato  3 , Shohei Fujita  2 , Hiroki Harada  2 , Motohiro Chuman  2 , Marie Washio  2 , Mikiko Sakuraya  2 , Masahiro Niihara  2 , Yusuke Kumamoto  4 , Takeshi Naitoh  5 , Keishi Yamashita  6
Affiliations

Appetite-preserving gastrectomy (APG) for esophagogastric junction cancer: preserving the residual stomach as an endocrine organ

Naoki Hiki et al. Gastric Cancer. 2025 May.

Abstract

Background: Loss of appetite following gastric cancer surgery, particularly total gastrectomy, significantly impacts patient quality of life due to the removal of the ghrelin-secreting region. We developed appetite-preserving gastrectomy (APG), a modified total gastrectomy that preserves this region.

Methods: Ten consecutive patients with esophagogastric junction cancer who were indicated for total gastrectomy and underwent APG between April 2023 and April 2024 were evaluated for early surgical outcomes, appetite, and changes in weight and body composition.

Results: There were no postoperative complications of grade II or higher (Clavien-Dindo classification). Appetite, assessed using the Simplified Nutritional Appetite Questionnaire, showed no significant impairment at 3 months (14.5 points, P = 0.82) and 6 months (15 points, P = 0.44) postoperatively compared with preoperative values. Oral calorie intake was maintained at 3 months (1675 kcal, P = 0.97) and 6 months (1675 kcal, P = 0.22) postoperatively compared with preoperative levels. The patients' body weight decreased by 9.2% at 6 months postoperatively compared with preoperative values, but their lean body mass remained stable. Although a significant decrease in the blood Ghrelin levels was observed postoperatively, 53% and 60.4% of the preoperative levels was maintained at one month and 6 months, respectively.

Conclusions: APG is a safe procedure that preserves the residual stomach as an endocrine organ, maintains ghrelin secretion and appetite, and prevents muscle loss. However, further trials are required to compare the efficacy of APG with total gastrectomy in preventing postoperative appetite loss.

Keywords: Appetite-preserving gastrectomy; Esophagogastric junction cancer; Ghrelin secretion; Lean body mass preservation; Quality of life after gastrectomy.

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Conflict of interest statement

Declarations. Conflict of interest: None reported.

Figures

Fig. 1
Fig. 1
a. Gastric transection for APG: After completion of the lymph node dissection, the duodenum was transected, followed by transection of the esophagus. A longitudinal gastric transection line was determined from outside the fornix No.2 lymph node region, and the line of dissection was determined where this intersected the gastrectomy line drawn from the anastomosis of the left epigastric artery and short gastric artery. b Reconstruction for APG: The esophago-jejunal anastomosis was performed using a circular stapler. The residual stomach and the elevated intestine were anastomosed using a linear stapler. The jejunal-jejunal anastomosis of the Rouen-Y anastomosis was then performed by conventional methods
Fig. 2
Fig. 2
a Changes in Simplified Nutritional Appetite Quetionnaire (SNAQ) score after APG, b Changes in calorie intake after APG, c Changes in serum albumin levels after APG, d Changes in body weight after APG, e Changes in body weight lean body mass after APG and f Changes in body weight lean body mass after APG
See this image and copyright information in PMC

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