Current status of laparoscopic gastrectomy for gastric malignancies.

Minimally invasive surgery for gastric cancer has been an important treatment modality since its introduction in 1991 from Japan. The practice of surgical techniques in laparoscopic gastrectomy with lymph node dissection is improving and evolving. Furthermore, advanced techniques including total gastrectomy, proximal gastrectomy, extended lymph node dissection and robot-assisted gastrectomy, have been safely carried out. A retrospective multicenter study in Japan has shown that the short-term outcomes of laparoscopic gastrectomy are beneficial, and the long-term outcomes are the same as those for open surgery. Recently, prospective multicenter randomized controlled trials have been conducted in Japan and Korea to evaluate the safety and oncological feasibility of laparoscopic gastrectomy for clinical stage I gastric cancer or advanced gastric cancer. In the future, laparoscopic surgeons will need to design and implement education and training systems for standard laparoscopic procedures based on the clinical outcomes of multicenter randomized controlled trials.