Current status, trends, and controversies in the selection of gastrectomy procedures: Insights from two nationwide questionnaire surveys conducted over a 7-year interval in Japan.

Aim: This study explores the evolving landscape of gastrectomy procedures in Japan, based on nationwide surveys conducted in 2014 and 2021. It highlights changes in surgical approaches, including a growing focus on minimally invasive and function-preserving procedures, as well as the increasing consideration of postoperative quality of life (QOL). Methods: Two nationwide questionnaire surveys were conducted in 2014 and 2021, targeting members of the Japanese Society for Gastro-surgical Pathophysiology. The surveys covered institutional characteristics, surgical case volumes, procedure preferences for early gastric cancer by tumor location, and emerging topics such as robot-assisted surgery and sentinel node navigation surgery. Statistical analysis included Fisher's exact test and residual analysis for changes in procedure selection over time. Results: The results indicate a marked shift toward laparoscopic and robot-assisted gastrectomy, alongside a rise in function-preserving procedures, particularly proximal gastrectomy and small remnant distal gastrectomy. However, procedures like pylorus-preserving gastrectomy and vagus nerve preservation, and total gastrectomy with jejunal pouch reconstruction remain underutilized due to concerns regarding unclear benefits, technical complexity, and oncological safety. Conclusion: This study underscores advancements in minimally invasive and function-preserving gastrectomy procedures in Japan but emphasizes the need for more robust clinical evidence to support the broader adoption of certain procedures. Future research, guided by emerging evaluation tools, is crucial for optimizing surgical outcomes and enhancing QOL for gastric cancer patients.