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

Abstract

Abstract:The World Health Organization (WHO) has declared gastric carcinoma a global health concern and gastric cancer remains the third leading cause of cancer deaths worldwide. With the rising incidence of gastric cancer, a body of both retrospective and randomized data has emerged since the early 1990's evaluating the role of minimally invasive platforms in the management of gastric cancer. While Eastern studies have shown that the laparoscopic approach is safe and feasible for advanced gastric cancer in Eastern patients, it is not clear whether this is true for patients in the West. Differences in tumor biology, stage at presentation, institutional volume, and surgeon experience all may impact the efficacy and widespread utilization of minimally invasive approaches in regions where gastric cancer is less prevalent. The majority of studies have pointed to a number of improvements associated with minimally invasive approaches including decreased blood loss, shorter length of hospital stay, lower analgesic requirements, decreased minor complications, and faster recovery without any significant difference in overall or disease specific survival (DSS). The benefits associated with minimally invasive approaches and evidence supporting similar oncologic outcomes compared to the traditional open approach will hopefully expand the indications for minimally invasive surgery in the management of gastric cancer. In the United States, results following initial experiences with minimally invasive techniques, including robotic platforms, have revealed promising results.Well-established laparoscopic and robotic techniques are emerging, particularly from high volume United States institutions, which will hopefully pave the way for increased utilization of minimally invasive surgery for gastric cancer in the West.

Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies

“…In a case-control study from a Western population, patients treated with laparoscopy-assisted gastrectomy more often received adjuvant chemotherapy when indicated [42] versus patients treated with an open approach. This finding is of particular importance for patients from the West, as their tumors are on average more advanced and their survival rates from gastric cancer treated by surgery alone are generally worse versus Eastern populations [43]. Adjuvant chemotherapy is standard for locally advanced gastric cancer in Eastern countries; correspondingly, three of the five included studies listed the administration of postoperative chemotherapy within the study protocol.…”

Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis

“…17,18 However, outside of high-volume centers, the majority of gastrectomies for gastric cancer continues to be done in an open fashion in the United States. 19 Since its approval by the Food and Drug Administration in 2000, roboticassisted techniques has been widely adopted by various surgical specialties due to its improved visualization and precision with dissection. 20 There have been several studies that demonstrate the feasibility of RA gastrectomy for total gastrectomy for malignancy; however, there is minimal literature comparing LA with RA gastrectomies.…”

Sorcin induces gastric cancer cell migration and invasion contributing to STAT3 activation

“…Gastric cancer has high mortality and mobility rate and is the third leading cause of cancer deaths [ 19 , 20 ]. Surgery and chemotherapy are the prime treatment for curing the malignancy [ 8 , 20 ].…”