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      Laparoscopic Surgery for Advanced Gastric Cancer: Current Status and Future Perspectives

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          Abstract

          Laparoscopic gastrectomy has been widely accepted especially in patients with early-stage gastric cancer. However, the safety and oncologic validity of laparoscopic gastrectomy for advanced gastric cancer are still being debated. Since the late 90s', we have been engaged in developing a stable and robust methodology of laparoscopic radical gastrectomy for advanced gastric cancer, and have established laparoscopic distinctive technique for suprapancreatic lymph node dissection, namely the outermost layer-oriented medial approach. In this article, We present the development history of this method, and current status and future perspectives of laparoscopic gastrectomy for advanced gastric cancer based on our experience and a review of the literature.

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          Epidemiology of gastric cancer.

          Katherine D Crew, Alfred I Neugut (2006)
          The incidence and mortality of gastric cancer have fallen dramatically in US and elsewhere over the past several decades. Nonetheless, gastric cancer remains a major public health issue as the fourth most common cancer and the second leading cause of cancer death worldwide. Demographic trends differ by tumor location and histology. While there has been a marked decline in distal, intestinal type gastric cancers, the incidence of proximal, diffuse type adenocarcinomas of the gastric cardia has been increasing, particularly in the Western countries. Incidence by tumor sub-site also varies widely based on geographic location, race, and socio-economic status. Distal gastric cancer predominates in developing countries, among blacks, and in lower socio-economic groups, whereas proximal tumors are more common in developed countries, among whites, and in higher socio-economic classes. Diverging trends in the incidence of gastric cancer by tumor location suggest that they may represent two diseases with different etiologies. The main risk factors for distal gastric cancer include Helicobacter pylori (H pylori) infection and dietary factors, whereas gastroesophageal reflux disease and obesity play important roles in the development of proximal stomach cancer. The purpose of this review is to examine the epidemiology and risk factors of gastric cancer, and to discuss strategies for primary prevention.
          Article 0 comments Cited 290 times – based on 0 reviews     Review now
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            Laparoscopy-assisted Billroth I gastrectomy.

            S Kitano, Y Iso, M. Moriyama … (1994)
            Laparoscopic distal partial gastrectomy is still technically difficult under conditions of a pneumoperitoneum because of the lack of appropriate techniques and laparoscopic instruments. We describe here a technique of laparoscopy-assisted Billroth I gastrectomy under an abdominal wall-elevating method.
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              D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer.

              Mitsuru Sasako, Takeshi Sano, Seiichiro Yamamoto … (2008)
              Gastrectomy with D2 lymphadenectomy is the standard treatment for curable gastric cancer in eastern Asia. Whether the addition of para-aortic nodal dissection (PAND) to D2 lymphadenectomy for stage T2, T3, or T4 tumors improves survival is controversial. We conducted a randomized, controlled trial at 24 hospitals in Japan to compare D2 lymphadenectomy alone with D2 lymphadenectomy plus PAND in patients undergoing gastrectomy for curable gastric cancer. Between July 1995 and April 2001, 523 patients with curable stage T2b, T3, or T4 gastric cancer were randomly assigned during surgery to D2 lymphadenectomy alone (263 patients) or to D2 lymphadenectomy plus PAND (260 patients). We did not permit any adjuvant therapy before the recurrence of cancer. The primary end point was overall survival. The rates of surgery-related complications among patients assigned to D2 lymphadenectomy alone and those assigned to D2 lymphadenectomy plus PAND were 20.9% and 28.1%, respectively (P=0.07). There were no significant differences between the two groups in the frequencies of anastomotic leakage, pancreatic fistula, abdominal abscess, pneumonia, or death from any cause within 30 days after surgery (the rate of death was 0.8% in each group). The median operation time was 63 minutes longer and the median blood loss was 230 ml greater in the group assigned to D2 lymphadenectomy plus PAND. The 5-year overall survival rate was 69.2% for the group assigned to D2 lymphadenectomy alone and 70.3% for the group assigned to D2 lymphadenectomy plus PAND; the hazard ratio for death was 1.03 (95% confidence interval [CI], 0.77 to 1.37; P=0.85). There were no significant differences in recurrence-free survival between the two groups; the hazard ratio for recurrence was 1.08 (95% CI, 0.83 to 1.42; P=0.56). As compared with D2 lymphadenectomy alone, treatment with D2 lymphadenectomy plus PAND does not improve the survival rate in curable gastric cancer. (ClinicalTrials.gov number, NCT00149279.) 2008 Massachusetts Medical Society
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Gastric Cancer
                Journal ID (iso-abbrev): J Gastric Cancer
                Journal ID (publisher-id): JGC
                Title: Journal of Gastric Cancer
                Publisher: The Korean Gastric Cancer Association
                ISSN (Print): 2093-582X
                ISSN (Electronic): 2093-5641
                Publication date (Print): March 2013
                Publication date (Electronic): 31 March 2013
                Volume: 13
                Issue: 1
                Pages: 19-25
                Affiliations
                Division of Upper Gastrointestinal Tract, Department of Surgery, Fujita Health University, Aichi, Japan.
                Author notes
                Correspondence to: Ichiro Uyama. Division of Upper Gastrointestinal, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 Japan. Tel: +81-562-93-9254, Fax: +81-562-93-9011, iuyama@ 123456fujita-hu.ac.jp
                Article
                DOI: 10.5230/jgc.2013.13.1.19
                PMC ID: 3627802
                PubMed ID: 23610715
                SO-VID: 9858c7bd-5d98-456d-adf4-70ec992d7dd8
                Copyright © Copyright © 2013 by The Korean Gastric Cancer Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 February 2013
                Date revision received : 06 March 2013
                Date accepted : 06 March 2013
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: laparoscopy,gastrectomy,stomach neoplasms,robotics,anastomosis, surgical
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: laparoscopy, gastrectomy, stomach neoplasms, robotics, anastomosis, surgical

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