J Korean Surg Soc.  2011 Sep;81(3):151-162. 10.4174/jkss.2011.81.3.151.

The current status and future perspectives of laparoscopic surgery for gastric cancer

• Kim HH
• Ahn SH

• KMID: 2212192
• DOI: http://doi.org/10.4174/jkss.2011.81.3.151

Abstract

Gastric cancer is most common cancer in Korea. Surgery is still the main axis of treatment. Due to early detection of gastric cancer, the innovation of surgical instruments and technological advances, gastric cancer treatment is now shifting to a new era. One of the most astonishing changes is that minimally invasive surgery (MIS) is becoming more dominant treatment for early gastric cancer. These MIS are represented by endoscopic resection, laparoscopic surgery, robotic surgery, single-port surgery and natural orifice transluminal endoscopic surgery. Among them, laparoscopic gastrectomy is most actively performed in the field of surgery. Laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) has already gained popularity in terms of the short-term outcomes including patient's quality of life. We only have to wait for the long-term oncologic results of Korean Laparoscopic Gastrointestinal Surgery Study Group. Upcoming top issues following oncologic safety of LADG are function-preserving surgery for EGC, application of laparoscopy to advanced gastric cancer and sentinel lymph node navigation surgery. In the aspect of technique, laparoscopic surgery at present could reproduce almost the whole open procedures. However, the other fields mentioned above need more evidences and experiences. All these new ideas and attempts provide technical advances, which will minimize surgical insults and maximize the surgical outcomes and the quality of life of patients.

Keyword

Gastric cancer; Future perspective; Laparoscopy; Sentinel lymph node navigation surgery; Minimally invasive surgery

MeSH Terms

Axis, Cervical Vertebra
Gastrectomy
Humans
Korea
Laparoscopy
Lymph Nodes
Natural Orifice Endoscopic Surgery
Nitriles
Pyrethrins
Quality of Life
Stomach Neoplasms
Surgical Instruments
Nitriles
Pyrethrins

Figure

• 

  Fig. 1 Protocol of sentinel lymph node navigation surgery in Seoul National University Bundang Hospital. EUS, endoscopic ultrasonography; CT, computed tomography; RI, radioisotope; H&E, hematoxylin & eosin; IHC, immunohistochemistry.

Reference

1. Stomach Cancer Incidence and Mortality Worldwide in 2008 Summary [Internet]. GLOBOCAN 2008: cancer fact sheet. c2010. cited 2011 July 15. Lyon: IARC;Available from: http://globocan.iarc.fr/factsheets/cancers/stomach.asp.

2. Cancer incidence rate [Internet]. c2008. updated 2010 Dec 29; cited 2011 July 15. Koyang (KR): National Cancer Information Center;Available from: http://www.cancer.go.kr/cms/statics/incidence/index.html#4.

3. Jung KW, Park S, Kong HJ, Won YJ, Boo YK, Shin HR, et al. Cancer statistics in Korea: incidence, mortality and survival in 2006-2007. J Korean Med Sci. 2010. 25:1113–1121.

4. Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, et al. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg. 2011. 98:255–260.

5. Jeong O, Park YK. Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer. 2011. 11:69–77.

6. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomizedTrial (KLASS Trial). Ann Surg. 2010. 251:417–420.

7. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005. 241:232–237.

8. Hwang SH, Park DJ, Jee YS, Kim MC, Kim HH, Lee HJ, et al. Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg. 2009. 144:559–564.

9. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008. 248:721–727.

10. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008. 248:793–799.

11. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, et al. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol. 2008. 15:2692–2700.

12. Lee HJ, Kim HH, Kim MC, Ryu SY, Kim W, Song KY, et al. The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer. Surg Endosc. 2009. 23:2473–2479.

13. Cho GS, Kim W, Kim HH, Ryu SW, Kim MC, Ryu SY. Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg. 2009. 96:1437–1442.

14. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005. 19:168–173.

15. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011. 14:113–123.

16. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004. 350:2050–2059.

17. Kim MG, Kawada H, Kim BS, Kim TH, Kim KC, Yook JH, et al. A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients. Surg Endosc. 2011. 25:1076–1082.

18. Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg. 2008. 12:1015–1021.

19. Pinkney J. Consensus at last? The International Diabetes Federation statement on bariatric surgery in the treatment of obese Type 2 diabetes. Diabet Med. 2011. 28:884–885.

20. Rubino F, Gagner M, Gentileschi P, Kini S, Fukuyama S, Feng J, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004. 240:236–242.

21. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004. 239:1–11.

22. Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K. A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg. 2008. 247:962–967.

23. Maki T, Shiratori T, Tsukamoto O. My method of gastrectomy with preservation of the pylorus. Shujutsu. 1969. 23:8–12.

24. Park DJ, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008. 32:1029–1036.

25. Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, et al. Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg. 2011. 253:928–933.

26. Adachi Y, Inoue T, Hagino Y, Shiraishi N, Shimoda K, Kitano S. Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction. Gastric Cancer. 1999. 2:40–45.

27. Takeshita K, Saito N, Saeki I, Honda T, Tani M, Kando F, et al. Proximal gastrectomy and jejunal pouch interposition for the treatment of early cancer in the upper third of the stomach: surgical techniques and evaluation of postoperative function. Surgery. 1997. 121:278–286.

28. Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery. 1998. 123:127–130.

29. An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg. 2008. 196:587–591.

30. Kim JH, Park SS, Kim J, Boo YJ, Kim SJ, Mok YJ, et al. Surgical outcomes for gastric cancer in the upper third of the stomach. World J Surg. 2006. 30:1870–1876.

31. Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T. Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach. Br J Surg. 2010. 97:558–562.

32. Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg. 2003. 90:850–853.

33. Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY. Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery. 2009. 146:469–474.

34. Usui S, Yoshida T, Ito K, Hiranuma S, Kudo SE, Iwai T. Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy. Surg Laparosc Endosc Percutan Tech. 2005. 15:309–314.

35. Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc. 2009. 23:2624–2630.

36. Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J, Nagayama S, et al. Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc. 2009. 23:2167–2171.

37. Park DJ, Lee JH, Lee MS, Lee HJ, Kim HH, Yang HK. Comparison of complications in end-to-side and side-to-side esophagojejunostomy after laparoscopy-assisted total gastrectomy for gastric cancer. J Korean Soc Endosc Laparosc Surg. 2010. 13:1–5.

38. Hur H, Jeon HM, Kim W. Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years' experience. J Surg Oncol. 2008. 98:515–519.

39. Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N. Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg. 2010. 211:33–40.

40. Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc. 2009. 23:1252–1258.

41. Lee J, Kim W. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol. 2009. 100:693–698.

42. Kosaka T, Ueshige N, Sugaya J, Nakano Y, Akiyama T, Tomita F, et al. Lymphatic routes of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis. Surg Today. 1999. 29:695–700.

43. Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, et al. Prospective multicenter trial of sentinel node mapping for gastric cancer [abstract]. 2009 ASCO Annual Meeting. J Clin Oncol. 2009. 27:15S. 4518.

44. Park DJ, Kim HH, Park YS, Lee HS, Lee WW, Lee HJ, et al. Simultaneous indocyanine green and (99m)Tc-antimony sulfur colloid-guided laparoscopic sentinel basin dissection for gastric cancer. Ann Surg Oncol. 2011. 18:160–165.

45. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009. 249:927–932.

46. Bucher P, Pugin F, Morel P. Single-port access laparoscopic radical left colectomy in humans. Dis Colon Rectum. 2009. 52:1797–1801.

47. Reavis KM, Hinojosa MW, Smith BR, Nguyen NT. Single-laparoscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg. 2008. 18:1492–1494.

48. Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T. Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc. 2011. 25:2400–2404.

49. Nakajima K, Nishida T, Takahashi T, Souma Y, Hara J, Yamada T, et al. Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: early experience in humans. Surg Endosc. 2009. 23:2650–2655.

50. Asakuma M, Nomura E, Lee SW, Tanigawa N. Ancillary N.O.T.E.S. procedures for early stage gastric cancer. Surg Oncol. 2009. 18:157–161.

51. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002. 131:1 Suppl. S306–S311.

52. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc. 2005. 19:1172–1176.

53. Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc. 2009. 23:1759–1763.

54. Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y. Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience. Surg Laparosc Endosc Percutan Tech. 2002. 12:204–207.

55. Yasuda K, Inomata M, Shiraishi N, Izumi K, Ishikawa K, Kitano S. Laparoscopy-assisted distal gastrectomy for early gastric cancer in obese and nonobese patients. Surg Endosc. 2004. 18:1253–1256.

56. Sakuramoto S, Kikuchi S, Kuroyama S, Futawatari N, Katada N, Kobayashi N, et al. Laparoscopy-assisted distal gastrectomy for early gastric cancer: experience with 111 consecutive patients. Surg Endosc. 2006. 20:55–60.

57. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007. 245:68–72.

58. Fujiwara M, Kodera Y, Misawa K, Kinoshita M, Kinoshita T, Miura S, et al. Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery. J Am Coll Surg. 2008. 206:138–143.

59. Song J, Lee HJ, Cho GS, Han SU, Kim MC, Ryu SW, et al. Recurrence following laparoscopy-assisted gastrectomy for gastric cancer: a multicenter retrospective analysis of 1,417 patients. Ann Surg Oncol. 2010. 17:1777–1786.