Laparoscopy-assisted resection of proximal gastric cancer: is less than all more or less complete, or is all more, nonetheless?

Abstract

The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2012 In this issue of Gastric Cancer, Ahn et al. [1] present a series of 131 patients with early-stage proximal gastric cancer who underwent laparoscopic resection, either in the form of laparoscopy-assisted total gastrectomy (LATG) or that of laparoscopy-assisted proximal gastrectomy (LAPG). The comparison of these two minimally invasive techniques with assessment of multiple early and late measures of outcomes is intriguing, and although not being based on a randomized trial deserves careful recognition and analysis. Fifty LAPG patients had lower intraoperative blood loss and operative times than 81 patients after LATG, but no obvious differences of early postoperative recovery or longer-term survival outcomes were found, with the main group differences consisting of delayed complications and functional parameters. The results generally appear to be excellent, with good postoperative outcomes indicative of proper patient selection and appropriate conduct of the operative procedures. With respect to a comparison of proximal versus total gastrectomy in a laparoscopy-assisted approach, these findings seem to resemble those results found after an open approach to total and proximal gastrectomy that showed no differences between the techniques regarding early postoperative and late oncological outcomes, but indicated possible functional differences between these groups [2]. Are the authors just wrapping the old debate on total versus proximal gastrectomy for proximal gastric cancer into a minimally invasive package here, or is their experience telling us more? We think that this series highlights several relevant aspects and poses some questions that deserve further comment.