Omentectomy is conducted for advanced gastric cancer (AGC) patients as radical surgery without an adequate discussion of the effect. This study was conducted to reveal the impact of omentum-preserving gastrectomy on postoperative outcomes. AGC patients with cT3 and 4 disease who underwent total or distal gastrectomy with R0 resection were identified retrospectively. They were divided into the omentum-preserved group (OPG) and the omentum-resected group (ORG) and matched with propensity score matching with multiple imputation for missing values. Three-year overall survival (OS) and 3-year relapse-free survival (RFS) were compared, and the first recurrence site and complications were analysed. The numbers of eligible patients were 94 in the OPG and 144 in the ORG, and after matching, the number was 73 in each group. No significant difference was found in the 3-year OS rate (OPG: 78.9 vs. ORG: 78.9, P = 0.54) or the 3-year RFS rate (OPG: 77.8 vs. ORG: 68.2, P = 0.24). The proportions of peritoneal carcinomatosis and peritoneal dissemination as the first recurrence site and the rate and severity of complications were similar in the two groups. Omentectomy is not required for radical gastrectomy for AGC.

The use of reduced port laparoscopic surgery (RPS) has become increasingly popular. The concept of RPS includes all procedures derived from various efforts minimizing the invasiveness of surgery, with single-incision laparoscopic surgery (SILS) being the ultimate reduced port technique. Reduced-port laparoscopic gastrectomy (RPLG) for gastric cancer has not yet been fully established and still has issues such as feasibility, oncological validity, training, and education. The short-term results of reported studies are acceptable. However, long-term results that verify positive results or radical cure even in cases of cancer have not yet been published. Patients for whom RPLG is indicated should be selected carefully. Prospective multicenter studies should be conducted to establish RPS as a truly evidence-based practice that addresses not only cosmesis but also the appropriate balance between minimal invasiveness and radical cure.

Introduction Reestablishing continuity after the Hartmann procedure, the Hartmann reversal has been recognized as a complex procedure with a high morbidity rate. Laparoscopic reversal of the Hartmann procedure (LHR) is technically challenging, although good short‐term results have been reported. We formulated this technique in 2013 and have been gradually devising and standardizing it. Material and Surgical Technique Ten patients who had undergone the Hartmann procedure from January 2013 to December 2019 and subsequently LHR were retrospectively examined. During the procedure, a circular incision was made at the original site of the colostomy to safely reach the abdominal cavity, and pneumoperitoneum was performed using the glove technique. Next, pelvic adhesions and the descending colon were dissected. If the rectal stump was difficult to identify, an intraoperative endoscope was used. Finally, either a Gambee or stapled anastomosis without tension was performed. The median surgical time was 265 minutes (range, 160‐435 minutes), and the median blood loss was 100 mL (range, 10‐700 mL). The median postoperative hospital stay was 11 days (range, 8‐14 days). In one case, laparotomy was performed because of severe intra‐abdominal adhesion. Discussion No major complication was observed during or after surgery. Therefore, LHR can be performed safely. Standardizing this procedure could render it minimally invasive, although a high level of evidence is needed.

Background Endoscopic submucosal dissection (ESD) is increasingly applied for early gastric cancer. ESD is a less invasive procedure and could be a radical treatment. However, in some cases, ESD cannot be completed owing to patient or technical factors. In such cases, which could have the potential for curative resection with ESD, standard gastrectomy is excessively invasive. Through closed laparoscopic and endoscopic cooperative surgery (LECS), gastric tumor can be precisely resected without exposing tumor cells to the abdominal cavity. Compared with standard gastrectomy, closed LECS is less invasive for the treatment of early gastric cancer. Case presentation We performed closed LECS for three cases of early gastric cancer after failed ESD. In all three cases, ESD was interrupted owing to technical and patient factors, including perforation, respiratory failure, and carbon dioxide narcosis. All three cases successfully underwent closed LECS with complete tumor resection and showed an uneventful postoperative course. All three patients remain alive and have experienced no complications or recurrence, with a median follow up of 30 (14–30) months. Conclusions Closed LECS is less invasive and useful procedure for the treatment of early gastric cancer, particularly in cases with difficulty in ESD.

Objective Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC. Methods Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into two groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups. Results Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 vs. 182.5 min; p = 0.026), lower blood loss (14 vs. 105 mL; p < 0.001), and shorter period to the first flatus passage (2 vs. 3 days; p < 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the two groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathological findings revealed that the laparoscopic group had a smaller tumor size (not pathological T category) and fewer metastatic lymph nodes than the open group leading to an earlier distribution of the pathological stage in the laparoscopic group. Conclusions LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.