Minimally Invasive Surgery for Gastric Cancer

Abstract

Since laparoscopic surgery for gastric cancer was introduced by Kitano et al. in 1991, an enthusiasm to develop laparoscopic procedures has grown steadily. In the initial phase, gastric cancer limited to the mucosal layer with no risk of lymph node metastasis was treated by laparoscopic wedge resection or intragastric mucosal resection. With advances in equipment and skill in laparoscopic surgery, the attention of surgeons then shifted to more radical procedures such as laparoscopic gastrectomy with lymph node dissection, which is comparable to open radical surgery and can be indicated even in advanced cancer. Several studies have shown that the short-and long-term outcomes of laparoscopic gastrectomy are beneficial for early gastric cancer and are the same as those for open surgery. With the introduction of robotic technology to laparoscopic gastric cancer surgery, extended radical lymph node dissection for advanced gastric cancer could become feasible and safe. Although we still have to solve several remaining issues in the treatment of advanced gastric cancers, laparoscopic surgery would enable us to apply a novel individualized minimally invasive approach, both in terms of degree of incision and extent of radical lymph node dissection.