Laparoscopic gastrectomy for cancer
- Joyce Wong, MD
Joyce Wong, MD
- Assistant Professor of Surgery
- Penn State Milton S. Hershey Medical Center
Gastrectomy for adenocarcinoma via an open abdominal approach (OG) has been performed since the 1920s. Laparoscopic gastrectomy (LG) was first described in Japan in 1994, where a distal gastrectomy with Billroth I gastroduodenostomy reconstruction was performed for an early-stage gastric cancer . Since then, surgical experience with LG has been increasing, particularly in Eastern countries such as Japan, Korea, and China, where gastric adenocarcinoma is more prevalent.
The indications, patient selection, surgical techniques, postoperative care, and outcomes of LG for cancer are discussed in this topic. OG and LG for benign diseases (eg, peptic ulcer) or weight loss are discussed in other topics. (See "Surgical management of peptic ulcer disease" and "Partial gastrectomy and gastrointestinal reconstruction" and "Total gastrectomy and gastrointestinal reconstruction" and "Bariatric procedures for the management of severe obesity: Descriptions" and "Surgical management of invasive gastric cancer".)
EASTERN VERSUS WESTERN EXPERIENCE
Eastern experience — LG is a well-established technique for treating gastric cancer in Eastern countries. According to national surveys, LG accounted for approximately 25 percent of all gastric surgeries performed for cancer in Japan and South Korea as early as 2009 . The efficacy of LG has been demonstrated for both early and locally advanced gastric cancers in Eastern countries.
Early gastric cancer — Early gastric cancer is defined as invasive gastric cancer that invades no more deeply than the submucosa, regardless of lymph node metastasis (T1, any N, M0) (table 1). Early gastric cancer is of particular importance to patients in East Asia, where it accounts for 25 to 50 percent of all gastric cancers diagnosed because of screening programs. (See "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging".)
An early Japanese study involving 1294 patients undergoing LG (91.5 percent distal gastrectomy) for gastric cancer from 1994 to 2003 showed mortality and morbidity rates of 0 and 14.8 percent and a recurrence rate of 0.6 percent at a median follow-up of three years . The five-year disease-free survival rate was 99.8 percent for stage IA disease, 98.7 percent for stage IB disease, and 85.7 percent for stage II disease.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EASTERN VERSUS WESTERN EXPERIENCE
- Eastern experience
- - Early gastric cancer
- - Locally advanced gastric cancer
- Western experience
- East versus West
- PATIENT SELECTION
- Provider factors
- - Surgeon experience
- - Hospital resources
- Patient factors
- - Comorbidities
- - Obesity
- - Previous abdominal surgery
- - Disease extent
- SURGICAL TECHNIQUES
- Laparoscopic total gastrectomy
- Laparoscopic distal gastrectomy
- POSTOPERATIVE CARE
- MINIMALLY INVASIVE ALTERNATIVES
- Robotic surgery
- Endoscopic resection
- SUMMARY AND RECOMMENDATIONS