J.Jpn. Surg. Soc.. 102(10): 749-752, 2001

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Feature topic

LAPAROSCOPIC SURGERY FOR GASTRIC CACNER:INDICATIONS AND LIMITATIONS

Gastric cancer has been successfully treated by both endoscopic and open surgery, while early-stage gastric cancer with some risk of lymph node metastasis is managed with laparoscopic surgery. The principle of treatment of gastric cancer is to perform a complete resection of the lesion with safe and appropriate procedures besed on disease stage. Three types of laparoscopic surgery have been reported:laparoscopy-assisted distal gastrectomy (LADG) ; laparoscopic local resection with the use a of aT-fastener ; and intragastric mucosal resection. In local resection, there is a possibility that past of the lesion or lymph node metastases may remain. D2 lymph node dissection requires a longer operative time and technical difficulties causing postoperative complications may be encountered. At present, LADG is the preferred choice of treatment in patients with early-stage gastric cancers due to the acceptable length of surgery and simple lymph node harvesting.
For the wider application of minimally invasive surgery, numerous advances in operative procedures, including hand-assisted surgery and sentinel node navigation surgery, are required, along with technical developments for more accurate diagnosis to offer ideal treatment for each stage of gastric cancer.

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