Minimally Invasive Surgery of Gastric Cancer

Abstract

Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short-and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Gastric cancer; Minimally invasive surgery; Laparoscopic gastrectomyCore tip: Minimally invasive surgery has become an alternative modality for the treatment of gastric cancer.Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20(39): 14132-14141 Available from: URL: http://www.wjgnet.com/1007-9327/full/ v20/i39/14132.htm DOI: http://dx.doi.org/10.3748/wjg.v20. tano et al [9] and Nagai et al [10] reported the success of laparoscopy-assisted distal gastrectomy (LADG) for EGC in 1994 and 1995. In the early 2000s, robot-assisted surgery emerged as one of the treatment modalities for EGC, and the first robot-assisted gastrectomy (RAG) for EGC was reported by Hashizume et al [11] in 2003. In 2011, singleincision laparoscopic surgery was described for EGC [12] . MIS has revolutionized the surgical approach to gastric cancer for the past two decades, leading to improvements in patients' quality of life by producing less pain, less blood loss, earlier postoperative recovery, and a shorter hospital stay [13][14][15][16][17][18][19] .Currently, MIS is evolving in two major directions [20] . First, MIS techniques are being used in more radical but less invasive procedures, such as totally laparoscopic distal gastrectomy or laparoscopic total gastrectomy with D1+ or D2 lymphadenectomy. These procedures are comparable to conventional open surgery and can be performed even in patients with advanced gastric cancer (AGC) [21][22][23] . Second, MIS is being employed for function-preserving surgery, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, and limited gastrectomy with sentinel node navigation surgery. These procedures can assist in improving patients' late postoperative function and quality of life [20,[24][25][26] . RECENT ADVANCES IN LAPAROSCOPIC GASTRECTOMYAs advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complicat...