Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

Abstract

Despite high mortality rates from gastric cancer, surgical management remains critical for curative potential. Optimal outcomes of gastric cancer resection depend on a multitude of variables, including the extent of resection, scope of lymphadenectomy, method of reconstruction, and potential for a minimally invasive approach. Laparoscopic gastrectomy, compared with open gastrectomy, has been analyzed in numerous randomized control trials. Generally, those trials demonstrated statistically similar postoperative complication rates, mortality, and oncologic outcomes between the two approaches. Although laparoscopic gastrectomy requires longer operative times, significant improvements in estimated blood loss, postoperative length of stay, and return of bowel function have been noted in patients who undergo laparoscopic gastrectomy. These short-term benefits, along with equivalent oncologic results, have influenced national guidelines in both Eastern and Western countries to recommend laparoscopy, especially for early stage disease. Although robotic gastrectomy has not been as widely validated in effective trials, studies have reported equivalent oncologic outcomes and similar or improved postoperative complication and recovery rates after robotic gastrectomy compared with open gastrectomy. Comparing the two minimally invasive gastrectomy approaches, robotic surgery was associated with improved estimated blood loss, incidence of pancreatic sequela, and lymph node harvests in some studies, whereas laparoscopy resulted in lower operative times and hospital costs. Ultimately, when applying outcomes from the literature to clinical patient care decisions, it is imperative to recognize these studies' range of inclusion criteria, delineating between patients originating from Eastern or Western countries, the use of neoadjuvant chemotherapy, the volume of surgeon experience, and the extent of gastrectomy, among others.

Application of laparoscopic surgery in gallbladder carcinoma

“…Laparoscopic gastrectomy leads to less blood loss, shorter hospital stays, and faster return of bowel function, at the expense of longer operation time. Due to the short- and long-term advantages, laparoscopic gastrectomy has been recommended in many national guidelines[ 29 ]. Moreover, laparoscopic liver resection has demonstrated better surgical outcomes, such as duration of hospitalization and postoperative complication rates, with similar overall survival and disease-free survival time, compared with open liver resection[ 30 ].…”

A narrative review of intraoperative use of indocyanine green fluorescence imaging in gastrointestinal cancer: situation and future directions

“…To improve patient survival, the principles of surgical oncology must be strictly adhered to, including complete resection of the tumor with negative margins and complete clearance of positive lymph nodes (LNs). However, numerous persistent issues in gastrointestinal cancer surgery remain poorly addressed, including intraoperative localization of the tumor, assessment of the extent of resection and anastomotic blood perfusion, and proper lymphadenectomy (4)(5)(6). In this context, the use of surgical tracers offers great convenience to the operator, such as classical carbon nanoparticles, methylene blue, recently emerging indocyanine green (ICG) dye, hyperspectral imaging, or multispectral imaging.…”