Appetite-preserving gastrectomy attenuates early postoperative deterioration of bone quality after surgery in esophagogastric junction cancer.

BACKGROUND

Bone loss after gastrectomy is a clinically important but often underestimated complication, particularly in elderly patients with gastric or esophagogastric junction (EGJ) cancer. Total gastrectomy (TG) has been associated with postoperative deterioration of bone health. Appetite-preserving gastrectomy (APG) preserves the ghrelin-secreting region of the stomach and maintains appetite and lean body mass; however, its impact on postoperative bone health remains unclear.

METHODS

This retrospective observational study included 28 patients with EGJ cancer who underwent curative gastrectomy between April 2023 and October 2025 (APG, n = 22; TG, n = 6). Bone mineral content (BMC) was assessed using bioelectrical impedance analysis, and vertebral bone attenuation was evaluated using CT-based L1 Hounsfield unit (HU) measurements preoperatively and at 6 and 12 months postoperatively. Nutritional parameters, serum ghrelin levels, and body composition were analyzed.

RESULTS

Baseline characteristics were comparable between groups. Changes in BMC did not differ significantly postoperatively. At 6 months, changes in L1 attenuation were similar between APG and TG. At 12 months, L1 attenuation was preserved in the APG group but declined markedly in the TG group (median ΔL1: +7.7 HU vs -30.9 HU, p = 0.0076). Postoperative serum ghrelin levels were partially preserved after APG, and postoperative reductions in body weight and lean body mass tended to be less pronounced.

CONCLUSIONS

APG may attenuated early postoperative deterioration of vertebral bone quality compared with TG. Preservation of the ghrelin-secreting region may mitigate early postoperative catabolic effects on musculoskeletal tissues, supporting APG as an endocrine-preserving surgical strategy for EGJ cancer.