Laparoscopic gastric cancer surgery: Current evidence and future perspectives

Abstract

Laparoscopic gastrectomy has been widely accepted as a standard alternative for the treatment of early-stage gastric adenocarcinoma because of its favorable short-term outcomes. Although controversies exist, such as establishing clear indications, proper preoperative staging, and oncologic safety, experienced surgeons and institutions have applied this approach, along with various types of function-preserving surgery, for the treatment of advanced gastric cancer. With technical advancement and the advent of state-of-the-art instruments, indications for laparoscopic gastrectomy are expected to expand as far as locally advanced gastric cancer. Laparoscopic gastrectomy appears to be promising; however, scientific evidence necessary to generalize this approach to a standard treatment for all relevant patients and care providers remains to be gathered. Several multicenter, prospective randomized trials in high-incidence countries are ongoing, and results from these trials will highlight the short- and long-term outcomes of the approach. In this review, we describe up-to-date findings and critical issues regarding laparoscopic gastrectomy for gastric cancer.

Keywords: Advanced gastric cancer; Early gastric cancer; Gastrectomy; Laparoscopic resection; Minimally invasive surgery; Stomach neoplasms.

Figure 1

Intraoperative view during distal subtotal gastrectomy with D2 lymph node dissection. A: Division of the greater omentum; B: Isolation of the LGEA and LGEV; C: Exposure of the RGEA, RGEV, and ASPDV; D: Isolation of the RGA; E: Dissection of the hepatoduodenal ligament, exposure of the PV and isolation of the LGV; F: Isolation and ligation of the LGA; G: Dissection along the SPA and SPV; H: Suprapancreatic view after D2 lymph node dissection. RGEA: Right gastroepiploic artery; LGEA: Left gastroepiploic artery; LGEV: Left gastroepiploic vein; RGEV: Right gastroepiploic vein; ASPDV: Anterior superior pancreaticoduodenal vein; RGA: Right gastric artery; LGA: Left gastric artery; SPA: Splenic artery; SPV: Splenic vein; CHA: Common hepatic artery; GDA: Gastroduodenal artery; IPA: Infrapyloric artery; LGV: Left gastric vein; PHA: Proper hepatic artery; PV: Portal vein; SGA: Short gastric artery; SGV: Short gastric vein.