Since 2016, the Gastric Cancer Committee has actively promoted China-Japan academic exchange by establishing a dedicated Chinese session at the JGCA annual meeting. In 2019, under the initiative and support of that year’s conference chair, Professor Masanori Terashima, the JGCA officially included the China-Japan Joint Session (JGCA-CGCA Joint Session) in the annual meeting agenda. Each year, the session centers on a key theme, such as neoadjuvant therapy for gastric cancer, conversion therapy, and tumors at the esophagogastric junction.
In 2025, the 97th JGCA Annual Meeting turned its focus to “Function-Preserving Surgery for Gastric Cancer,” inviting experts from both countries to share insights and clinical practices surrounding this important and increasingly relevant topic.
Professor Naoki Hiki Introduces Appetite-Preserving Gastrectomy (APG): A New Surgical Approach from Japan
To explore the safety and feasibility of APG, Professor Hiki’s team conducted a prospective study from April 2023 to April 2024, involving 10 patients who underwent the procedure. The study assessed short-term surgical outcomes, changes in appetite, body weight, and body composition. Results showed a median operative time of 459 minutes and a median estimated blood loss of 632 mL. Pathological analysis confirmed negative resection margins, and no postoperative complications of Clavien-Dindo grade II or higher were observed. There were no postoperative deaths, and the median hospital stay was 9 days.
These findings indicate that APG is a safe surgical technique that preserves part of the stomach as an endocrine organ, helping to maintain ghrelin secretion and appetite while preventing muscle loss. However, further comparative studies are needed to evaluate APG’s effectiveness against traditional total gastrectomy in mitigating postoperative appetite loss.
Professor Hui Cao on the Current Landscape of Function-Preserving Gastrectomy in China
Professor Hui Cao from Renji Hospital, Shanghai Jiao Tong University, delivered a comprehensive overview of function-preserving gastrectomy (FPG) in China. He highlighted that China sees over 100,000 new cases of early gastric cancer (EGC) annually, underscoring the substantial need for surgical techniques that preserve gastric function.
FPG has been receiving increasing attention from Chinese surgeons. Last year, a Chinese expert consensus on function-preserving gastrectomy was released. The consensus outlines major surgical strategies for EGC, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, segmental gastrectomy, local resection, and endoscopic resection. It also provides guidance on assessing the function of the remnant stomach and managing function-related complications.
PPG, in particular, has been well adopted by Chinese surgeons, with both total laparoscopic and robot-assisted PPG procedures now being practiced. Clinical research conducted at Renji Hospital has demonstrated the safety and feasibility of PPG. For proximal gastrectomy, the most common reconstruction methods in China are esophagogastrostomy and double-tract reconstruction.
Looking ahead, Professor Cao emphasized that precise surgical dissection and anatomical understanding will be key to advancing FPG in China. He also called for more robust research and data collection to support Chinese surgeons in refining and expanding these techniques.
Advances in Function-Preserving Gastrectomy: Insights from Japan and China
Professor Souya Nunobe from Japan delivered an in-depth presentation on representative function-preserving procedures after gastrectomy, focusing on pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG)—both of which aim to mitigate the functional impairments commonly seen after gastric resection.
Japanese Perspective on PPG and PG
PPG is indicated for early-stage gastric cancer located in the mid-stomach, at least 4 cm away from the pyloric ring. Key surgical steps include preserving the inferior pyloric artery and vein, avoiding direct manipulation of the preserved pyloric ring, and limiting dissection at the esophagogastric junction (EGJ). These steps may contribute to reducing the risk of postoperative gastric stasis and reflux.
PG is primarily indicated for early cancers in the upper stomach or those located at the EGJ. The preferred reconstruction technique is the double-flap technique (DFT), including its modified “tunnel” approach. A sufficient length of esophageal insertion and a wide anastomosis are critical to preventing reflux and anastomotic stricture.
According to the data presented, the rate of gastric stasis following PPG was 6.2%, with risk factors including advanced age, diabetes, and intra-abdominal infection. Reflux occurred in 15% of cases. For PG-DFT, anastomotic stricture was observed in approximately 8% of patients, with preoperative CT showing an esophageal diameter of less than 18 mm identified as a risk factor. When the length of the resected esophagus was less than 5 cm, the rate of postoperative reflux esophagitis was 2.8%; this increased to 13% when the resection length was greater than 5 cm.
By fully understanding the strengths and limitations of PPG and PG, surgeons can integrate these concepts into practice to optimize outcomes.
Chinese Innovations in Function-Preserving Surgery
Professor Ziyu Li from Beijing Cancer Hospital gave a detailed overview of the evolution of Chinese consensus on function-preserving surgery and shared recent developments in the field. With the rising incidence of adenocarcinoma of the esophagogastric junction (AEG), proximal gastrectomy with functional preservation has gained increasing attention in surgical treatment.
Professor Li introduced the Chinese expert consensus on reconstruction following proximal gastrectomy and shared his team’s clinical experience. They developed a modified version of the Kamikawa double-flap technique, referred to as the “arched-bridge” reconstruction, and successfully performed this technique in over 30 cases.
In this approach, the median time for esophagogastric anastomosis was around 20 minutes, while the muscle flap creation took about 14 minutes—significantly shorter than times reported in previous literature for the traditional double-flap method. Importantly, the reconstruction preserved the anti-reflux benefits of the tunnel-based double-flap technique. To date, there have been no instances of anastomotic leakage, and the stricture rate was 6.7% (2 cases), both managed successfully with a single session of endoscopic balloon dilation.
This modified approach not only simplifies the procedure and reduces operative time, but also shows promising short-term results, making it a viable and scalable solution for improving postoperative quality of life in gastric cancer patients.
About the Expert
Professor Ziyu Li President and Deputy Party Secretary, Beijing Cancer Hospital Director, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Professor Ziyu Li is a leading surgical oncologist and educator, currently serving as President of Beijing Cancer Hospital. He is also a professor, chief physician, and doctoral advisor, and has been recognized as a recipient of the State Council Special Allowance for distinguished experts.
Professor Li holds prominent positions in several national academic and medical associations, including:
- Vice President, Chinese Anti-Cancer Association (CACA)
- Chair, Committee on Surgical Safety and Quality Control, CACA
- Vice Chair, CACA Gastric Cancer Committee
- Chair, Oncology Surgery Expert Panel, Surgical Branch, Chinese Medical Doctor Association
- Member, Gastrointestinal Surgery Group, Surgery Branch, Chinese Medical Association
- Vice President, Beijing Anti-Cancer Association
In 2019, he received the prestigious “Golden Lancet Award” as part of the “Respecting Life – Honoring Physicians” initiative.
As first or corresponding author, Professor Li has published over 100 SCI-indexed papers. He has led numerous national and provincial-level research projects, including several funded by the National Natural Science Foundation of China. He is also the chief editor of key surgical texts, including:
- Notes on Laparoscopic Gastrointestinal Surgery
- Challenges and Strategies in Laparoscopic Gastric Cancer Surgery
Professor Ziyu Li: Function-Preserving Surgery for Gastric Cancer—A Shared Global Pursuit
“This year’s joint China-Japan session centers on function-preserving surgery for gastric cancer, a topic of common concern among physicians around the world who are dedicated to the treatment of this disease,” remarked Professor Ziyu Li.
He noted that countries like Japan and South Korea have achieved remarkable progress in gastric cancer screening, with early-stage gastric cancer accounting for over 60–70% of diagnoses. Since early gastric cancer is highly curable—with more than 90% of patients achieving long-term survival—attention has naturally shifted to improving quality of life after treatment. “When the effectiveness of surgery is well-established, it’s only natural to focus on how to minimize the impact of treatment on patients’ postoperative quality of life,” he said. “This concept has been around for decades and is now gaining greater recognition and acceptance.”
The session featured speeches from both Chinese and Japanese speakers, including Congress Chair Professor Jiafu Ji and renowned Japanese surgeon Professor Naoki Hiki. Professor Hiki, known for pioneering combined endoscopic and laparoscopic approaches, presented a novel surgical method—appetite-preserving gastrectomy (APG). He shared the first report of 10 cases in which the gastric fundus, a ghrelin-rich region, was preserved in an effort to improve patients’ postoperative quality of life. Though based on a small sample, the initial findings are promising, and experts at the session engaged in thoughtful discussions regarding surgical indications and future directions.
Professor Hui Cao also delivered an impressive overview of the development of pylorus-preserving gastrectomy (PPG) in China, highlighting his team’s contributions. Notably, Professor Xiang Hu, one of the pioneers of this procedure in China, was also in attendance.
