Local resection of the stomach for gastric cancer

Abstract

The local resection of the stomach is an ideal method for preventing postoperative symptoms. There are various procedures for performing local resection, such as the laparoscopic lesion lifting method, non-touch lesion lifting method, endoscopic full-thickness resection, and laparoscopic endoscopic cooperative surgery. After the invention and widespread use of endoscopic submucosal dissection, local resection has become outdated as a curative surgical technique for gastric cancer. Nevertheless, local resection of the stomach in the treatment of gastric cancer in now expected to make a comeback with the clinical use of sentinel node navigation surgery. However, there are many issues associated with local resection for gastric cancer, other than the normal indications. These include gastric deformation, functional impairment, ensuring a safe surgical margin, the possibility of inducing peritoneal dissemination, and the associated increase in the risk of metachronous gastric cancer. In view of these issues, there is a tendency to regard local resection as an investigative treatment, to be applied only in carefully selected cases. The ideal model for local resection of the stomach for gastric cancer would be a combination of endoscopic full-thickness resection of the stomach using an ESD device and hand sutured closure using a laparoscope or a surgical robot, for achieving both oncological safety and preserved functions.

Cirugía gástrica laparoendoscópica cooperativa

“…Una parte importante de nuestros pacientes fueron llevados a procedimientos cooperativos por el fracaso de procedimientos convencionales como sangrados gástricos intratables, bordes positivos laterales y profundos, y la imposibilidad de llevar a cirugía convencional, laparoscópica o abierta, a pacientes con múltiples comorbilidades. A pesar de su amplio campo de aplicación, los casos deben ser cuidadosamente seleccionados evitando la deformación gástrica y el deterioro funcional, garantizando un margen quirúrgico seguro 11 .…”

Lymphatic Routes of Gastric Cancer Metastasis Elucidated by Triple Lymph Node Analysis

“…The results have strongly influenced the Japanese Classification of Gastric Carcinoma [3]. Kinami et al [6][7][8] have advocated a lymphatic basin theory of the stomach as the proper pattern of lymphatic in early gastric cancer, and demonstrated the physiological lymphatic flow in the stomach. Although our results supported the lymphatic basin theory to some extent, it should be pointed out that the lymphatic flow might be different from these physiological flows when many lymph nodes are involved by gastric cancer cells.…”

Laparoscopic sentinel node navigation surgery for early gastric cancer

“…Preserved structures include the celiac, hepatic, and pyloric branches of the vagal nerve; the hepatic plexus; pylorus; and proximal side of stomach. There are various types of function-preserving gastrectomy, including proximal gastrectomy (7), pylorus-preserving gastrectomy (9), minimal distal gastrectomy, segmental gastrectomy (10,11), and local (wedge) resection (12).…”

“…Therefore, the most promising approach for laparoscopic function-preserving gastrectomy is likely to be local resection of the stomach (12).…”

“…"Local resection of the stomach" refers to a surgical procedure involving full-thickness, resection of a part of the gastric wall (12); the term is synonymous with "wedge resection". The advantage of local resection is that it minimizes functional impairment.…”