Current status and future perspectives of laparoscopic radical surgery for advanced gastric cancer

Abstract

Laparoscopic radical gastrectomy with lymph node dissection has widely penetrated to East Asian countries, where incidence of gastric cancer occurrence is higher than the rest of the world. Laparoscopic distal gastrectomy for cStageI disease is regarded as one of the option in daily practice in the latest Japanese guidelines; however its applicability to more advanced disease (Stage II/III) is still under debate. Actually, operative techniques of laparoscopic D2 dissection is being matured, but still, necessity of total omentectomy, splenic hilar dissection, management of bulky nodes or large primary tumor, high-level anastomosis in esophageal invasion cases, and extensive peritoneal lavage can be raised as technical limitations. In the future perspective, further technological innovation, including next generation surgical robot, may help surgeons overcome these difficulties. Currently, three large-scaled randomized phase-III clinical trials are ongoing in East Asia, in which patients' accruals have been already completed. With coming long-term outcomes of these well-designed studies, oncological validity of laparoscopic approach will be adequately elucidated.

Open vs. laparoscopic surgery for locally advanced gastric cancer after neoadjuvant therapy: Short‑term and long‑term survival outcomes

“…The number of metastatic lymph nodes harvested in the LG group was less than that in the OG group (2.4 vs. 6.0; P<0.0001). Laparoscopic procedures have certain limitations, such as difficult management of tumors with bulky metastasis-positive nodes or large primary tumors, and unusual tissue fibrosis or edema may present following neoadjuvant therapy, which further increases surgical difficulty (21). Therefore, the majority of doctors select conventional OG.…”

Laparoscopic lymph nodes dissection for advanced gastric cancer: the current status and the perspective

“…Robotic surgical instruments seem to have potential to cover disadvantages of LG, such as insufficiency of forceps' degree of freedom or surgeons' physiological tremor at the tip of device [35] . It is suggested by experts that the use of a surgical robot may be beneficial for more complicated procedures, including more advanced cancer disease [36] . Although a number of robot-assisted gastrectomy (RAG) are rapidly increasing since RAG has been covered by insurance in April 2018 in some limited institutes, several issues remain to be solved regarding clinical indication, short-and long-term outcomes, cost-effectiveness, and stress of surgeons [37][38][39] .…”

Laparoscopic Surgery for Gastric Cancer

“…In the latest ongoing clinical trials, short-term results have been shared. While, laparoscopic surgery for advanced GC has a complication rate of 16.4%, it is 24.3% for open surgery [35][36][37]. These studies will be finalized in 2018.…”