Published online Feb 15, 2010. doi: 10.4251/wjgo.v2.i2.65
Revised: July 25, 2009
Accepted: August 1, 2009
Published online: February 15, 2010
Surgical resection remains the mainstay of treatment for gastric cancer. Laparoscopic assisted gastrectomy has failed to gain universal acceptance as an alternative to the open approach for a number of reasons, one of which includes the issue of oncological radicality in terms of lymph node dissection. Nodal status, which is one of the most crucial and independent predictors of patient survival, therefore has been examined both in single institutional trials and also in randomised controlled trials especially on early gastric cancer. The issue of oncological adequacy for laparoscopic lymph node harvesting for advanced gastric cancer remains a contentious issue because of the unique challenges it poses in terms of complexity, safety and time, and also the lack of randomised controlled trials in this area. It is thus imperative that good quality multicentre randomised controlled trials are designed to investigate the benefits of extended lymphadenectomy in the setting of laparoscopic surgery, especially for advanced gastric cancer and its impact on both short and long term survival.
Minimal access gastrointestinal surgery for gastric cancer; i.e. laparoscopic distal gastrectomy (LDG), has not achieved universal acceptance by the surgical fraternity although introduced 13 years ago. The reasons are both technical and oncological. Recently, however, there has been a tremendous amount of advancement in the development of laparoscopic instruments which, coupled with increasing experience in the performance of complex laparoscopic gastrointestinal procedures, have led to the expansion of minimal access surgery for both benign and malignant gastric procedures. The following editorial will discuss some of these contentious issues and progress made in this area.