Is Laparoscopic Approach Also Safe for the Treatment of Remnant Gastric Cancer?

• Published in: Journal of minimally invasive surgery Vol. 22; no. 1; pp. 3 - 4
• Main Author: Song, Kyo Young
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Endoscopic and Laparoscopic Surgeons 01.03.2019; 대한내시경복강경외과학회
• Subjects: 일반외과학; Gastric remnant; Laparoscopy; Lymph node dissection; Gastrectomy; Gastric cancer
• ISSN: 2234-778X; 2234-5248
• DOI: 10.7602/jmis.2019.22.1.3

The most important advantages of laparoscopic gastrectomy are the minimal invasiveness, including less postoperative pain, shorter recovery, and minimal complications. A laparoscopic distal gastrectomy is accepted widely as a standard treatment for gastric cancer. On the other hand, a laparoscopic total gastrectomy has not been popularized as a distal gastrectomy because of the complexity of a lymph node dissection and the diversity of reconstruction. In terms of laparoscopic surgery for a remnant gastrectomy, there are three key points, which are critical for safe operation: adequate lymph node dissection, meticulous adhesiolysis, and reconstruction. After radical surgery for gastric cancer, the intra-abdominal condition is greatly changed. In addition, the lymphatic anatomy around the stomach is broken and surgeons should be aware of a newly developed lymphatic system to perform adequate node dissection. An esophago-jejunal reconstruction is at risk of leakage. Until evidence that is more concrete can be obtained, experienced surgeons should consider the laparoscopic approach.