Minimally invasive surgery for gastric cancer in UK: current status and future perspectives

Abstract

The aim of this study is to review the literature and report the various minimally invasive methods used to treat gastric cancer in the UK and compare it with worldwide practice. Published randomised studies, non-randomised studies and case series reporting the use of minimal invasive approach to treat gastric cancer were retrieved from the search of standard medical electronic databases and their outcomes were highlighted suggesting their effectiveness. Several randomised, controlled trials and metaanalyses have proven the clinical and oncological safety of the laparoscopic gastrectomy for gastric cancer.Similarly, robot-assisted gastrectomy, EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection) have also been proven feasible and safe to treat gastric cancer of various stages in prospective and retrospective comparative studies. However, UK based studies on minimally invasive surgery to treat gastric cancer is scarce and the paucity of trials led to uncertain outcomes. Laparoscopic gastrectomy, robot-assisted gastrectomy, EMR and ESD are feasible procedures in terms of clinical and oncological safety but mainly being practiced in Asian countries with high prevalence of stomach cancer. The UK based practice is still small and limited but the introduction of MIGOCS and STOMACH trial might help to widen the application of this technique.

Quality performance indicator compliance for the treatment of gastric adenocarcinoma

“…These results reflect the timeframe of the study where these techniques were less prevalent. Compared to its employment in the United Kingdom where GA incidence rates are similar, EMR rates have similar rates of utilization 11 . In contrast, series from Japan show EMR rates of 94% in eligible populations due in part to both expertise and the presence of a screening program 9 .…”

“…Compared to its employment in the United Kingdom where GA incidence rates are similar, EMR rates have similar rates of utilization. 11 In contrast, series from Japan show EMR rates of 94% in eligible populations due in part to both expertise and the presence of a screening program. 9 Unlike countries where GA is more prevalent and with established screening programs, patients in this study tended to have higher stage GA at the time of diagnosis.…”

Cirugía Mínimamente Invasiva del Cáncer Gástrico.

“…En occidente, la implementación de la cirugía laparoscópica para cáncer gástrico ha sido mucho más lenta en comparación a oriente [28][29][30] . La principal razón de este atraso se debe en parte a que en nuestros países la gran mayoría de los pacientes con este diagnóstico, debutan con tumores avanzados (compromiso transmural), diseminación linfática extensa o, definitivamente, con diseminación de distancia; lo que entorpece y desincentiva iniciar una experiencia segura en cirugía laparoscópica 31 .…”