Quality of life after Billroth I gastrectomy was significantly better in patients in whom a laparoscopic technique was used than in those who underwent a conventional method. LAG is less invasive and better accepted by patients and is the procedure of choice for the treatment of early gastric cancer.

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Morphologic peritoneal alterations after pneumoperitoneum differed from those after laparotomy and were influenced by the type of gas, amount of pressure, and duration of insufflation. These peritoneal changes after pneumoperitoneum may be associated with a specific intraperitoneal tumor spread after laparoscopic cancer surgery.

Laparoscopic-assisted proximal gastrectomy was performed in two Japanese patients with early gastric carcinomas located in the gastric cardia. The lower esophagus and upper stomach was divided under the pneumoperitoneum and resected via a minilaparotomy through an incision, 5 cm long, made in the epigastric area. The distal esophagus was anastomosed to a gastric tube made by resecting the lesser curvature of the stomach with a linear auto-stapler. Both patients recovered quickly without any postoperative complications, such as esophagitis, developing during follow-up periods of 3 and 6 months, respectively. Thus, we conclude that laparoscopic-assisted proximal gastrectomy and reconstruction with a gastric tube may be an effective method of treatment for patients with early gastric carcinomas located in the upper stomach in this era of minimally invasive surgery.

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