V102 No 7 BULLETIN American College of Surgeons
ACS CLINICAL RESEARCH PROGRAM
and location of the tumor, prior
abdominal surgery, patient body
habitus, and surgeon experience.
Laparoscopic gastrectomy is a
technically challenging operation;
for distal gastrectomies, it has been
suggested that surgeons may need to
complete up to 90 cases to achieve
proficiency. 16 For total gastrectomies,
as many as 100 cases may be needed. 17
Multiple ongoing randomized
trials to evaluate the efficacy
of laparoscopic gastrectomy,
both for early cancers and for
advanced disease, are in process
(see Table 1, page 69).
A high-quality patient outcome
should always take precedence over
surgical approach (open versus
laparoscopic). However, as surgical
experience with minimally invasive
techniques grows and as technology
advances, it is becoming clear that
minimally invasive appropriate
resections can play an important role
in the care of well-selected gastric
cancer patients. The indications
for this approach continue to
advance and may provide benefits
for our patients, not only in faster
recovery times and other minimally
invasive benefits, but perhaps even
in terms of fewer complications and
quicker initiation of recommended
adjuvant treatments. ♦
7. Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal
gastrectomy compared with open distal gastrectomy for stage I gastric
cancer: Short-term outcomes from a multicenter randomized controlled trial
(KLASS-01). Ann Surg. 2016;263( 1): 28-35.
8. Zhang CD, Chen SC, Feng ZF, Zhao ZM, Wang JN, Dai DQ. Laparoscopic
versus open gastrectomy for early gastric cancer in Asia: A meta-analysis.
Surg Laparosc Endosc Percutan Tech. 2013; 23( 4):365-377.
9. Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic
versus open distal gastrectomy for gastric cancer: A meta-analysis of
randomized controlled trials and high-quality nonrandomized studies. Ann
Surg. 2012;255( 3):446-456.
10. Kim KH, Kim MC, Jung GJ, Choi HJ, Jang JS, Kwon HC. Comparative
analysis of five-year survival results of laparoscopy-assisted gastrectomy
versus open gastrectomy for advanced gastric cancer: A case-control study
using a propensity score method. Dig Surg. 2012; 29( 2):165-171.
11. Bo T, Peiwu Y, Feng Q, et al. Laparoscopy-assisted vs. open total
gastrectomy for advanced gastric cancer: long-term outcomes and technical
aspects of a case-control study. J Gastrointestinal Surg. 2013; 17( 7):1202-1208.
12. Fang C, Hua J, Li J, et al. Comparison of long-term results between
laparoscopy-assisted gastrectomy and open gastrectomy with D2
lymphadenectomy for advanced gastric cancer. Am J Surg. 2014;208( 3):391-396.
13. Cai J, Wei D, Gao CF, Zhang CS, Zhang H, Zhao T. A prospective
randomized study comparing open versus laparoscopy-assisted D2 radical
gastrectomy in advanced gastric cancer. Dig Surg. 2011; 28( 5-6):331-337.
14. Martinez-Ramos D, Miralles-Tena JM, Cuesta MA, et al. Laparoscopy versus
open surgery for advanced and resectable gastric cancer: A meta-analysis.
Rev Esp Enferm Dig. 2011;103( 3):133-141.
15. Choi Y Y, Bae JM, An J Y, Hyung WJ, Noh SH. Laparoscopic gastrectomy
for advanced gastric cancer: Are the long-term results comparable with
conventional open gastrectomy? A systematic review and meta-analysis.
J Surg Oncol. 2013;108( 8):550-556.
16. Zhang X, Tanigawa N. Learning curve of laparoscopic surgery for gastric
cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc.
2009; 23( 6):1259-1264.
17. Jung DH, Son SY, Park YS, et al. The learning curve associated with
laparoscopic total gastrectomy. Gastric Cancer. 2016; 19( 1):264-272.
Patient selection is critical for achieving acceptable outcomes
with minimally invasive gastrectomy. Important considerations
include size and location of the tumor, prior abdominal
surgery, patient body habitus, and surgeon experience.