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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (2): 301-306. doi: 10.19723/j.issn.1671-167X.2026.02.012

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Clinical efficacy and safety of totally laparoscopic subtotal gastrectomy with cardia-gastric fundus preservation in middle-upper gastric cancer

Youdong LIU1, Yajun LYU2, Jie CHEN1, Mingde ZANG1, Hongda PAN1, Xiaowen LIU1, Jun LU1, Fenglin LIU1,*()   

  1. 1. Department of Gastric Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
    2. Department of General Surgery, Hukou County People's Hospital of Jiangxi Province, Hukou 332500, Jiangxi, China
  • Received:2025-12-03 Online:2026-04-18 Published:2026-02-25
  • Contact: Fenglin LIU
  • Supported by:
    the National Nature Science Foundation of China(82373381); the National Nature Science Foundation of China(82172803)

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Abstract:

Objective: To investigate the clinical efficacy and safety of totally laparoscopic radical subtotal gastrectomy with preservation of the cardia and partial gastric fundus in the treatment of middle-upper gastric cancer. Methods: A retrospective cohort study was conducted on 41 patients with middle and upper gastric cancer admitted to Fudan University Shanghai Cancer Center from January to June 2025. The patients were divided into an observation group (n=21) and a control group (n=20) according to the surgical method. The observation group underwent totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation, while the control group received laparoscopic total gastrectomy. Perioperative surgical indicators, postoperative recovery, complications, pathological results, and follow-up data on nutritional status were observed and compared between the two groups. Results: All patients in both groups successfully completed the surgery without conversion to open surgery or surgical modification during the operation. The average total operative time in the observation group was (156.1±14.2) min, which was significantly shorter than (169.8±6.7) min in the control group (P < 0.05). There were no significant differences in the time of digestive tract reconstruction and intraoperative blood loss between the two groups (P>0.05). The average time to first oral water intake, first liquid diet intake and postoperative hospital stay in the observation group were (2.1±0.4) d, (3.4±0.5) d and (6.3±0.5) d, respectively, all significantly shorter than those in the control group (2.9±0.6) d, (3.9±0.5) days and (7.1±1.0) d, all P < 0.05. No perioperative complications such as anastomotic leakage or postoperative bleeding occurred in either group. Pathological results showed no significant differences in postoperative pathological stage and number of dissected lymph nodes between the two groups (P>0.05). No tumor recurrence or metastasis was identified during the postoperative follow-up period.The proportion of patients with decreased body mass index (BMI) compared with preoperative level in the observation group was 23.8%, which was significantly lower than 50.0% in the control group (P=0.046). The serum vitamin B12 level in the observation group 3 months after surgery was (416.0±145.3) ng/L, significantly higher than (315.0±128.2) ng/L in the control group (P=0.026). Conclusion: Totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation can ensure the radicality of tumor resection for middle and upper gastric cancer. Compared with laparoscopic total gastrectomy, it has the advantages of shorter operative time, faster postoperative recovery, better maintenance of postoperative nutritional status and quality of life in patients, with reliable safety. It may serve as a novel individualized therapeutic option for patients with middle and upper gastric cancer.

Key words: Stomach neoplasms, Subtotal gastrectomy, Roux-en-Y, Treatment outcomes

CLC Number: 

  • R735.2

Figure 1

Schematic diagram of surgical steps for totally laparoscopic radical subtotal gastrectomy"

1
段海涛, 梁品. 胃癌保功能外科手术的研究进展[J]. 中华胃肠外科杂志, 2025, 28 (2): 210- 216.
2
中华医学会外科学分会胃肠外科学组, 中国医师协会外科医师分会肿瘤外科学组, 中国医师学会外科医师分会上消化道学组, 等. 中国胃癌保功能手术外科专家共识(2025版)[J]. 中华胃肠外科杂志, 2025, 28 (2): 109- 120.
3
中国抗癌协会胃癌专业委员会. 局部进展期胃癌规范化淋巴结清扫范围中国专家共识(2022版)[J]. 中华胃肠外科杂志, 2022, 25 (4): 277- 283.
4
Jiang X , Hiki N , Nunobe S , et al. Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: A novel surgical procedure for selected early gastric cancer in the upper stomach[J]. Gastric Cancer, 2011, 14 (2): 194- 199.

doi: 10.1007/s10120-011-0023-7
5
Ohwada S , Nakamura S , Ogawa T , et al. Segmental gastrectomy for early cancer in the mid-stomach[J]. Hepatogastroenterology, 1999, 46 (26): 1229- 1233.
6
杜建军, 王为忠, 李纪鹏, 等. 远端极量胃次全切除术[J]. 中国实用外科杂志, 2007, 27 (9): 727- 729.
7
胡礼, 杨力, 严志龙, 等. 全腹腔镜次全胃切除术在中上部早期胃癌治疗中的应用[J]. 腹腔镜外科杂志, 2022, 27 (1): 23- 27.
8
Olmi S , Giorgi R , Cioffi SPB , et al. Total and subtotal laparoscopic gastrectomy for the treatment of advanced gastric cancer: Morbidity and oncological outcomes[J]. J Laparoendosc Adv Surg Tech, 2018, 28 (3): 278- 285.

doi: 10.1089/lap.2017.0372
9
中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会腹腔镜与内镜外科学组, 中国抗癌协会胃癌专业委员会. 完全腹腔镜胃癌手术消化道重建专家共识及手术操作指南(2018版)[J]. 中国实用外科杂志, 2018, 38 (8): 833- 839.
10
崔昊, 卫勃. 功能保留性胃切除术后消化道重建术式的分类及选择策略[J]. 中华胃肠外科杂志, 2021, 24 (5): 392- 396.
11
Yalikun A , Aikemu B , Li S , et al. A modified billroth-Ⅱ with Braun anastomosis in totally laparoscopic distal gastrectomy: Initial experience compared with Roux-en-Y anastomosis[J]. Ann Surg Oncol, 2022, 29 (4): 2359- 2367.

doi: 10.1245/s10434-021-11187-4
12
崔昊, 刘国晓, 邓欢, 等. 全3D腹腔镜远端胃切除术Billroth Ⅱ联合Braun吻合与Roux-en-Y吻合的近期疗效分析[J]. 中华消化外科杂志, 2021, 20 (5): 528- 534.
13
Kamiya S , Ohashi M , Ida S , et al. Laparoscopic subtotal gastrectomy with a new marking technique, endoscopic cautery marking: Preservation of the stomach in patients with upper early gastric cancer[J]. Surg Endosc, 2018, 32 (11): 4681- 4687.

doi: 10.1007/s00464-018-6272-3
14
Gajardo JA , Arriagada FJ , Muñoz FD , et al. Subtotal versus total gastrectomy for distal diffuse-type gastric cancer[J]. Surg Endosc, 2024, 38 (12): 7588- 7595.

doi: 10.1007/s00464-024-11268-x
15
Saeed M , Murshid KR , Rufai AA , et al. Coexistence of multiple anomalies in the celiac-mesenteric arterial system[J]. Clin Anat, 2003, 16 (1): 30- 36.

doi: 10.1002/ca.10093
16
Zhu G , Jiao X , Zhou S , et al. Can proximal gastrectomy with double-tract reconstruction replace total gastrectomy? A meta-analysis of randomized controlled trials and propensity score-matched studies[J]. BMC Gastroenterol, 2024, 24 (1): 230.

doi: 10.1186/s12876-024-03323-7
17
Junttila A , Helminen O , Helmiö M , et al. Postoperative delayed emptying after total, subtotal, or distal gastrectomy for gastric cancer: A population-based study[J]. J Gastrointest Surg, 2024, 28 (7): 1083- 1088.

doi: 10.1016/j.gassur.2024.04.026
18
Wang HM , Wang TJ , Huang CS , et al. Nutritional status and related factors in patients with gastric cancer after gastrectomy: A cross-sectional study[J]. Nutrients, 2022, 14 (13): 2634.

doi: 10.3390/nu14132634
19
Ni X , Tan Z , Ding C , et al. A region-resolved mucosa proteome of the human stomach[J]. Nat Commun, 2019, 10, 39.

doi: 10.1038/s41467-018-07960-x
20
Zhao Y , Liu Y , Tao T , et al. Gastric mechanosensitive channel Piezo1 regulates ghrelin production and food intake[J]. Nat Metab, 2024, 6 (3): 458- 472.

doi: 10.1038/s42255-024-00995-z
21
Takachi K , Doki Y , Ishikawa O , et al. Postoperative ghrelin levels and delayed recovery from body weight loss after distal or total gastrectomy[J]. J Surg Res, 2006, 130 (1): 1- 7.
22
Yang X , Zeng Z , Liao Z , et al. Comparison of proximal gastrectomy and total gastrectomy in proximal gastric cancer: A meta-analysis of postoperative health condition using the PGSAS-45[J]. BMC Cancer, 2024, 24 (1): 1282.

doi: 10.1186/s12885-024-13046-3
23
Kano Y , Ohashi M , Ida S , et al. Oncological feasibility of laparoscopic subtotal gastrectomy compared with laparoscopic proximal or total gastrectomy for cT1N0M0 gastric cancer in the upper gastric body[J]. Gastric Cancer, 2019, 22 (5): 1060- 1068.

doi: 10.1007/s10120-019-00947-7
24
Furukawa H , Kurokawa Y , Takiguchi S , et al. Short-term outcomes and nutritional status after laparoscopic subtotal gastrectomy with a very small remnant stomach for Stage Ⅰ proximal gastric carcinoma[J]. Gastric Cancer, 2018, 21 (3): 500- 507.

doi: 10.1007/s10120-017-0755-0
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