J Gastric Cancer.  2013 Mar;13(1):19-25.

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

  • 1Division of Upper Gastrointestinal Tract, Department of Surgery, Fujita Health University, Aichi, Japan. iuyama@fujita-hu.ac.jp


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.


Laparoscopy; Gastrectomy; Stomach neoplasms; Robotics; Anastomosis, surgical

MeSH Terms

Anastomosis, Surgical
Lymph Node Excision
Stomach Neoplasms


  • Fig. 1 Forceps and hemostats specialized for advanced laparoscopic surgery. 1a: Finger type Maryland Dissection forceps "WA64300A"; 1b: Left-hand type Grasping forceps "WA64360A"; 1c: Ultrasonic Surgical System "SonoSurg X"; 1d: Suction and irrigation tube with button electrode "WA51138A+WA51172S"; 1e: Johann type Bipolar Grasping forceps "WA64120C".

  • Fig. 2 Outermost layer between the autonomic nerve sheath of the common hepatic artery and adipose tissue bearing #8a lymph nodes.



  • Fig. 5 AirSeal System.


1. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006. 12:354–362.
2. Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004. 22:2767–2773.
3. NCCN Guidelines Version 2. 2011. Gastric Cancer;http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
4. Bamboat ZM, Strong VE. Minimally invasive surgery for gastric cancer. J Surg Oncol. 2013. 107:271–276.
5. Wei HB, Wei B, Qi CL, Chen TF, Huang Y, Zheng ZH, et al. Laparoscopic versus open gastrectomy with D2 lymph node dissection for gastric cancer: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2011. 21:383–390.
6. Angst E, Hiatt JR, Gloor B, Reber HA, Hines OJ. Laparoscopic surgery for cancer: a systematic review and a way forward. J Am Coll Surg. 2010. 211:412–423.
7. Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, et al. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc. 2013. 27:286–294.
8. Fujii M, Sasaki J, Nakajima T. State of the art in the treatment of gastric cancer: from the 71st Japanese Gastric Cancer Congress. Gastric Cancer. 1999. 2:151–157.
9. Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer. 2011. 14:97–100.
10. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. Japan Clinical Oncology Group. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008. 359:453–462.
11. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011. 14:113–123.
12. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004. 22:2069–2077.
13. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010. 11:439–449.
14. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Surgical Co-operative Group. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer. 1999. 79:1522–1530.
15. Kimura T, Kimura K, Suzuki K, Sakai S, Ohtomo Y, Sakuramachi S, et al. Laparoscopic cholecystectomy: the Japanese experience. Surg Laparosc Endosc. 1993. 3:194–198.
16. Koeda K, Nishizuka S, Wakabayashi G. Minimally invasive surgery for gastric cancer: the future standard of care. World J Surg. 2011. 35:1469–1477.
17. Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S. Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg. 2012. 36:331–337.
18. Uyama I, Ogiwara H, Takahara T, Kato Y, Kikuchi K, Iida S. Laparoscopic Billroth I gastrectomy for gastric ulcer: technique and case report. Surg Laparosc Endosc. 1995. 5:209–213.
19. Uyama I, Ogiwara H, Takahara T, Furuta T, Kikuchi K, Iida S. Laparoscopic minilaparotomy Billroth I gastrectomy with extraperigastric lymphadenectomy for early gastric cancer using an abdominal wall-lifting method. J Laparoendosc Surg. 1995. 5:181–187.
20. Uyama I, Ogiwara H, Takahara T, Kikuchi K, Iida S. Laparoscopic and minilaparotomy proximal gastrectomy and esophagogastrostomy: technique and case report. Surg Laparosc Endosc. 1995. 5:487–491.
21. Uyama I, Ogiwara H, Iida S, Takahara T, Furuta T, Kikuchi K. Laparoscopic minilaparotomy pancreaticoduodenectomy with lymphadenectomy using an abdominal wall-lift method. Surg Laparosc Endosc. 1996. 6:405–410.
22. Uyama I, Ogiwara H, Takahara T, Kikuchi K, Iida S. Gasless laparoscopic and minilaparotomy Billroth I gastrectomy with hepatectomy for advanced gastric cancer with liver metastasis : technique and case report. Minim Invasive Ther Allied Technol. 1996. 5:281–285.
23. Uyama I, Ogiwara H, Takahara T, Kikuchi K, Iida S, Kubota T, et al. Spleen- and pancreas-preserving total gastrectomy with superextended lymphadenectomy including dissection of the para-aortic lymph nodes for gastric cancer. J Surg Oncol. 1996. 63:268–270.
24. Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hasumi A. Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach. Gastric Cancer. 2000. 3:50–55.
25. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999. 2:230–234.
26. Kanaya S, Haruta S, Kawamura Y, Yoshimura F, Inaba K, Hiramatsu Y, et al. Video: laparoscopy distinctive technique for suprapancreatic lymph node dissection: medial approach for laparoscopic gastric cancer surgery. Surg Endosc. 2011. 25:3928–3929.
27. Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg. 2009. 144:1138–1142.
28. Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, et al. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg. 2002. 195:284–287.
29. Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg. 2010. 211:e25–e29.
30. Hosogi H, Kanaya S. Intracorporeal anastomosis in laparoscopic gastric cancer surgery. J Gastric Cancer. 2012. 12:133–139.
31. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994. 4:146–148.
32. Kodera Y, Fujiwara M, Ohashi N, Nakayama G, Koike M, Morita S, et al. Laparoscopic surgery for gastric cancer: a collective review with meta-analysis of randomized trials. J Am Coll Surg. 2010. 211:677–686.
33. Gordon AC, Kojima K, Inokuchi M, Kato K, Sugihara K. Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer. Surg Endosc. 2013. 27:462–470.
34. Lee JH, Ahn SH, Park do J, Kim HH, Lee HJ, Yang HK. Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg. 2012. 36:2394–2399.
35. Suda K, Ishida Y, Kawamura Y, Inaba K, Kanaya S, Teramukai S, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg. 2012. 36:1608–1616.
36. Isogaki J, Haruta S, Man-I M, Suda K, Kawamura Y, Yoshimura F, et al. Robot-assisted surgery for gastric cancer: experience at our institute. Pathobiology. 2011. 78:328–333.
37. Seehofer D, Mogl M, Boas-Knoop S, Unger J, Schirmeier A, Chopra S, et al. Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments. Surg Endosc. 2012. 26:2541–2549.
38. Kong SH, Oh BM, Yoon H, Ahn HS, Lee HJ, Chung SG, et al. Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera. Surg Endosc. 2010. 24:1132–1143.
39. Horstmann M, Horton K, Kurz M, Padevit C, John H. Prospective comparison between the airSeal(®) system valve-less trocar and a standard versaport™ plus V2 trocar in robotic-assisted radical prostatectomy. J Endourol. 2013. [Epub ahead of print].
40. Herati AS, Atalla MA, Rais-Bahrami S, Andonian S, Vira MA, Kavoussi LR. A new valve-less trocar for urologic laparoscopy: initial evaluation. J Endourol. 2009. 23:1535–1539.
Full Text Links
  • JGC
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr