Minimally invasive surgery for serosa-positive gastric cancer (pT4a) in patients with preoperative diagnosis of cancer without serosal invasion

Abstract

Similar survival and recurrence patterns were observed in advanced gastric cancer patients preoperatively diagnosed as serosa negative who were treated either by MIS or open surgery. MIS may be safely applied in patients with serosa-positive tumors.

Minimally Invasive Surgery for Gastric Cancer Treatment: Current Status and Future Perspectives

“…However, the sample sizes were too small to report on stage-specific survival rates. In our experience, even serosa-positive cancer (T4a) patients treated using MIS experienced similar survival and recurrence outcomes, compared to open surgery 15. The results of a meta-analysis demonstrated that compared with open surgery, laparoscopic gastrectomy with D2 LN dissection had similar overall survival rates, comparable numbers of retrieved LNs, less blood loss, less pain, reduced postoperative complications, and shorter hospital stays 41.…”

“…However, inaccurate preoperative staging and a subsequent limited extent of surgery is an important issue. Many studies have shown that MIS does not increase peritoneal seeding or port site metastasis, even when used in cases of AGC 3,15,16,17,18,19…”

“…Because of an inaccurate perioperative diagnosis, a significant number of patients with AGC have been treated using minimally invasive approaches 15. Therefore, the results of treating advanced cancer with MIS should be investigated.…”

“…Therefore, the results of treating advanced cancer with MIS should be investigated. Although there is no evidence and there are no guidelines that indicate that the use of MIS is appropriate, even for EGC, experienced surgeons have begun to treat patients with AGC using MIS, and have reported acceptable short-term outcomes 2,4,5,15,37,38. For some selected AGC cases, surgeons believe that this approach is not inferior to open conventional surgery in terms of the oncologic aspects.…”

“…Experienced surgeons have reported oncologic outcomes of the use of MIS for AGC 4,5,6,15,17,37,38,39,40. MIS for locally advanced cancer has a similar survival rate compared to open conventional surgery.…”