Long-term pancreatic volume after function-preserving gastrectomy based on the sentinel node concept versus total gastrectomy for gastric cancer

Gastrectomy induces pancreatic atrophy, linked to exocrine pancreatic insufficiency and nutritional decline. We investigated whether function-preserving gastrectomy based on the sentinel node concept is associated with less postoperative pancreatic atrophy than total gastrectomy (TG). In this multicenter retrospective study, 105 patients with Stage I/II gastric cancer underwent sentinel node navigation surgery (SNNS, n = 33) or TG (n = 72) between 2002 and 2020, all recurrence-free through 5 years. Pancreatic volume was measured on computed tomography-based volumetry preoperatively and at 1, 3, and 5 years; the primary outcome was relative pancreatic volume (%PV). Median %PV was higher in the SNNS group at every time point (year 1, 87.3% vs. 77.4%; year 3, 87.1% vs. 76.2%; year 5, 89.5% vs. 71.3%; all P < 0.001). On multivariate analysis, surgical procedure was independently associated with %PV at 5 years (P = 0.002), and this association remained significant in the sensitivity analyses. The relative duct-parenchymal ratio at 5 years was greater in the TG group (P = 0.044). Function-preserving gastrectomy based on the sentinel node concept was associated with better pancreatic volume preservation than TG. This difference reflects the combined effects of the extent of gastric resection and lymphadenectomy and requires prospective confirmation.