Current Status and Controversy of Laparoscopic Radical Gastrectomy for Gastric Cancer

Abstract

The surgical treatment effect of gastric cancer is still dissatisfactory in China. Great progress has been made in clinical outcome of gastric cancer after surgical treatment, esp. advanced stage Ⅲ cancer because of high surgical quality control in our center. The safety and effectiveness of laparoscopic radical gastrectomy for early gastric cancer has been confirmed by many large scale, multi-center clinical trials. Laparoscopic radical resection was recommended as the optional treatment for clinical stage I distal gastric cancer in China and Japan. Laparoscopic radical resection for advanced gastric cancer remained some limitations including surgical difficulty in lymphadenectomy, radical extent and long learning curve. More clinical trials were being carried out to confirm the feasibility, effectiveness and long-term survival of laparoscopic radical resection for advanced gastric cancer in China, Japan and Korea. With the development of surgical technique, further optimization of surgical procedures, proficiency of surgical operation, the indications of laparoscopic radical resection for advanced gastric cancer would be expanded. Laparoscopic surgery could achieve routine lymphadenectomy, or extended and even skeletonized lymphadenectomy in some large volume specialties. The role of bursectomy for advanced gastric cancer is still controversial. Laparoscopic bursectomy was safe and feasible if performed by experienced surgeons. This article also summarized our experience of laparoscopic bursectomy for advanced gastric cancer. With the development of laparoscopic surgery technology and equipments, as well as the experience accumulation and proficiency of surgical operation, laparoscopic surgery could achieve safety and the same radical extent compared with open surgery. It is necessary to carry out relevant clinical studies to further elaborate the advantages and disadvantages of laparoscopic surgery in the treatment of gastric cancer. Key words: Stomach neoplasms; Laparoscopy; Lymph node excision