Hand-assisted laparoscopic gastrectomy for cancer: The next last frontier

Abstract

Listen

Translate article

5 urgical history is rife with declarations that “it has all been one, there is no place to go from here.” With the article ublished in this month’s Journal of the American College of urgeons, it would appear that minimally invasive extended adical gastrectomy has now been successfully conquered ith techniques by Uyama and colleagues from the Fujita ealth University in Aichi, Japan. Minimally invasive surery of the esophagus, from fundoplication to esophagecomy, has been developed and perfected in populations of uropean descent, but nearly all credit for the development f minimally invasive surgery of the stomach belongs to sia, and the art has been no better perfected than in Japan. n 1991, Kitano and Shiraishi performed the first aparoscopic-assisted distal gastrectomy for early gastric ancer. After that, laparoscopic gastric wedge resection and ntragastric mucosal resection were described by Ohgami nd colleagues and Ohashi, respectively. These three techiques are widely used in Japan for treatment of early gastric ancer that cannot be managed with flexible endoscopic ethods (using a mucosal lift technique), yet show no evdence of invasion deep to the mucosa. In a recent review of he subject by Kitano and Shiraishi, more than 4,000 such rocedures were reviewed. Although these large numers still represent the minority (20% to 30%) treatment f early gastric cancer in Japan, this represents significant enetration of the field by laparoscopy. This utilization ate exceeds that of laparoscopic hernia in the US and is bout on a par with laparoscopic appendectomy. Clearly, ost “advanced” laparoscopic surgeons in Japan are usng these techniques to manage early gastric cancer. Now ere comes the extension of these techniques to the more dvanced gastric cancers, one in which the stage of the isease necessitates resection of adjacent organs, includng the spleen and pancreas. Laparoscopic D3 dissection s described and is clearly “doable” by these skilled sureons. The data in this article suggest that there is indeed benefit to the patient when minimally invasive techiques are used. Although it is conceivable that hand-assisted laparocopic radical gastrectomy will become the next “gold stanard,” my best guess is that it will be viewed in 10 years as a