Minimally invasive surgery in advanced gastric cancer

Abstract

According to GLOBOCAN 2018, there were over 1 000 000 new cases of GC in 2018 and an estimated 783 000 deaths, making it the fifth most frequently diagnosed cancer and the third leading cause of cancer death worldwide. 1 The traditional treatment option for GC is surgical resection, which includes gastrectomy with D2 lymph node dissection after laparotomy. However, several less invasive procedures and minimally invasive surgeries (MISs) have been developed to reduce the invasiveness of surgery and improve patients' quality of life. In 1994, Dr. Seigo Kitano first introduced laparoscopyassisted distal gastrectomy (LADG) for early gastric cancer (EGC).Since then, based on many studies and clinical trials, the laparoscopic approach has become increasingly established in GC surgery. 2 In addition, even more popular than LADG, a totally laparoscopic gastrectomy technique has been developed to reduce surgical wound and surgical stress compared to laparoscopic-assisted methods. In 2009, Ikeda et al reported the advantages of totally laparoscopic distal gastrectomy (TLDG) over LADG as less invasive, secure ablation of the tumor with the stomach, and safe anastomosis. 3 Chen et al reported that TLDG had a longer surgery time but less bleeding and shorter hospitalization than open gastrectomy (OG) in a systematic review including one randomized controlled trial (RCT) and 13 observational studies. 4 In eastern Asian countries, several study groups have been established as a platform to organize and conduct prospective RCTs in each country; for example, the Japanese Clinical Oncology Study Group (JCOG) in Japan, the Korean Laparoscopic Gastrointestinal Surgical Study Group (KLASS) in South Korea, and the Chinese Laparoscopic Gastrointestinal Surgical Study Group (CLASS) in China to evaluate the safety and feasibility of MIS on GC. In Korea, the KLASS-01 trial has proven the efficacy of laparoscopic distal gastrectomy (LDG) vs open subtotal gastrectomy for clinical stage I GC with better short-term outcomes and equivalent long-term survival. 5,6 In Japan, similar results have been demonstrated for LDG vs open distal gastrectomy for clinical stage IA/IB GC in the JCOG 0912 trial. 7,8 In China, the safety of laparoscopic total gastrectomy

Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

“…Importantly, two recent RCTs have reported short-term postoperative and survival outcomes following RG, 38 , 39 and anticipation among gastroesophageal surgeons is that such minimally invasive approaches should enhance patient outcomes. 40 Therefore, application of the network meta-analysis (NMA) methodology here is timely to allow simultaneous comparison (direct and indirect) of minimally invasive approaches to gastrectomy with OG using RCT data only. 41 , 42 …”

Strictureplasty in Pediatric Crohn's Disease

“…Initial experience with this technique evolved from its use in India as a treatment for intestinal strictures secondary to tuberculosis (11). Subsequently, the successful use of strictureplasty in adults with Crohn's disease was reported (12)(13)(14).…”