Function-preserving surgery in gastric cancer: current evidence and implications for the West

Background: Gastric cancer remains a significant global health challenge. Surgical resection continues to be the cornerstone of treatment, but traditional gastrectomy is often associated with negative impacts on nutritional status and quality of life. Function-preserving surgical techniques, widely adopted in East Asian countries due to early cancer detection, have shown promise in improving postoperative outcomes. In contrast, Western guidelines have yet to integrate these procedures into routine practice. Main body: Function-preserving surgeries, including pylorus-preserving gastrectomy and proximal gastrectomy, aim to maintain gastric function while ensuring oncological safety. These procedures are primarily indicated for early gastric cancers and have demonstrated comparable survival outcomes to standard resections in well-selected patients. Endoscopic resections and segmental gastrectomy represent additional function-sparing options under investigation. The main functional complications, such as gastric stasis or reflux esophagitis, have prompted the development of various reconstructive techniques, including double-tract methods, jejunal interposition, and pouch reconstructions. Despite their proven benefits in Eastern countries, the implementation of these surgeries in Western settings is limited. Challenges include the lower incidence of early gastric cancer, lack of surgeon experience, and absence of guideline endorsement. However, increased centralization of care, enhanced diagnostic accuracy, and growing emphasis on patient-reported outcomes have reignited interest in adapting these strategies for Western populations. Additionally, emerging evidence suggests that even patients with more advanced disease may benefit from improved short-term functional outcomes, potentially aiding in faster recovery and return to adjuvant therapies. Conclusion: Function-preserving surgery in gastric cancer offers oncologically safe alternatives that may significantly improve postoperative quality of life and nutritional outcomes. As global treatment paradigms evolve, adapting these techniques in the West, particularly within high-volume centers, could represent a significant step forward. Further randomized trials and Western-centric data are essential to validate the broader applicability of these procedures and refine patient selection criteria.