Laparoscopic Gastrectomy for Cancer

Abstract

There are three procedures for the management of early gastric cancer (EGC): laparoscopic wedge resection (LWR), intragastric mucosal resection (IGMR), and laparoscopic gastrectomy. LWR or IGMR can be applied to treat EGC without the risk of lymph node metastasis. However, owing to the recent technical advances in endoscopic mucosal resection for EGC, the use of laparoscopic local resection for these lesions has gradually decreased. On the other hand, laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy, is widely accepted for the treatment of EGC with the risk of lymph node metastasis. To establish the acceptability of laparoscopic gastrectomy with D2 lymph node dissection against advanced gastric cancers, safe techniques and new instruments must be developed. The following advantages of laparoscopic surgery for the treatment of gastric cancer have been well demonstrated: clinical course after operation, pulmonary function, immune response. In the future, laparoscopic surgeons have to design and implement education and training systems for standard laparoscopic procedures, evaluate clinical outcomes by multicentric randomized control trial studies, and clarify the oncological aspects of laparoscopic surgery in basic studies.

Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects

“…The incidence of lymph node metastasis in a large EGC series ranges from 1% to 3% for tumors confined to the mucosa and from 11% to 20% for tumors invading the submucosa [3]. On the basis of these findings, the Japanese Gastric Cancer Association guidelines recommend optimal lymph node dissection levels for EGC as follows: D1+a for mucosal cancer and D1+b for submucosal cancer without lymph node metastasis [11].…”

Gastrectomia parcial videoassistida para câncer gástrico precoce

“…Most studies have emphasised -even with LAG not fully performed by laparoscopy -, the presence of several benefits for patients with EGC, who undergo these procedures, instead of laparotomy gastrectomy only 1,3,4,5,6,7,9,10,12,13,14,18,19,20,22,23,24,26,27 . Among them, was highlighted: a) the best cosmetic appearance; b) lower rate of intraoperative bleeding; c) less pain; d) faster recovery of postoperative ileus; e) early feedback; f) shorter hospital stay with consequent lower cost; g) lower overall rate of postsurgical complications (especially pulmonary, infectious); h) better immune response; i) lower formation of intraperitoneal adhesions; j) reducing the incidence of postgastrectomy syndromes (especially gastric dumping syndrome) and k) earlier return to labour activities.…”

“…However, considering minimally invasive surgery techniques have come up, laparoscopicassisted gastrectomy (LAG) began to be performed especially for potentially metastatic cases in regional lymph nodes 5,13,18,27 (Figura 1) 15 . Considering such less invasive approach, it can improve the morbimortality and speed up the postoperative recovery of patients in substitution of gastrectomies for laparotomy, without jeopardising the safety of the surgical procedure 1,3,4,6,7,9,10,12,13,19,20,22,23,24,26,27 . This review covers the current situation regarding the use of laparoscopic-assisted gastrectomy for the surgical treatment of EGC.…”

Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

“…Since the field of view of the surgical site is limited and it was still difficult to systematically dissect regional lymph nodes, no standardized procedure has been established. 5 Flexible laparoscopes were developed for gastrointestinal endoscopy to expand the field of vision by allowing overhead or side-arm laparoscopy procedures and may facilitate standardization of the LADG procedures. 6 The purpose of this study was to clarify the safety and value of laparoscopic surgery for gastric cancer.…”