Strategies for gastric cancer in the modern era

Abstract

Gastric cancer is one of the most common neoplasms in Japan, and it is also the second leading cause of cancer-related deaths worldwide. Nowadays, infection with Helicobacter pylori (H. pylori) is a known risk factor for the development of gastric cancer. Therefore, gastric cancer should be considered as an infectious disease, and in fact, prophylactic eradication of H. pylori may prevent the development of metachronous gastric carcinoma. Before the role of H. pylori was understood, a different approach was used. Recently even after the cancer has developed, some newer therapeutic approaches have been pursued. These newer treatments have been summarized as "minimally invasive therapies" and use endoscopic or laparoscopic techniques. In addition, robotic approaches are being developed that seem to hold a great potential to change the surgical approach. Since basic understanding and treatment of the disease have both changed significantly over the last decade, we present a review of current advances in gastric cancer research and therapy.

Keywords: Endoscopic submucosal dissection; Gastric cancer; Helicobacter pylori; Laparoscopy-assisted distal gastrectomy; Robot.

Figure 1

Laparoscopy-assisted distal gastrectomy with the voice- controlled robot AESOP. AESOP holds the laparoscope.

Figure 2

Transgastrostomic ultrathin scope passing through the pyloric stricture (A) and percutaneous endoscopic jejunostomy feeding tube placed for palliative therapy (B).

Figure 3

New strategies for gastric cancer. If a patient develops cancer and even if it is diagnosed at an early stage, it may be resectable using less invasive endoscopic submucosal dissection or laparoscopy-assisted gastrectomy (LAG). In the case of advanced stage cancers, instead of open gastrectomy, LAG may also be possible and newer, more effective chemotherapy may be applicable. In case of non-curative advanced gastric cancer, various less invasive therapies may be feasible as best supportive care. m^a: Except for poorly differentiated adenocarcinoma; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; OG: Open gastrectomy; BSC: Best supportive care.