Totally laparoscopic surgery for gastric cancer.

Laparoscopic surgery for gastric cancer has become a popular procedure in East Asian countries such as Korea and Japan,1 and the advantages of this approach for gastric cancer surgery have been clearly demonstrated in several clinical studies.2-5 The most commonly performed laparoscopic procedures for gastric cancer include the omentectomy and the lymphadenectomy. However, minimal laparotomy is required for resection and reconstruction with these procedures.

Recent surgical innovations have focused on minimizing trauma for surgical patients. In the field of laparoscopic surgery for gastric cancer, experienced surgeons want to begin performing surgical procedures such as intracorporeal anastomosis without minilaparotomy, which is referred to as totally laparoscopic surgery. Although there are no proven clinical results for this approach, surgeons hope to reduce postoperative pain and enhance recovery through totally laparoscopic surgery. Hosogi and Kanaya6 published a review article about intracorporeal anastomosis in the most recent issue of the Journal of Gastric Cancer and reported that most clinical studies of intracorporeal anastomosis have demonstrated its technical feasibility. However, comparative studies between totally laparoscopy and conventional laparoscopy-assisted surgery are lacking.

This issue of the Journal of Gastric Cancer includes three clinical studies that compare totally laparoscopic surgery or intracorporeal anastomosis to laparoscopy-assisted surgery for gastric cancer.7-9 Two of these article discuss overcoming the learning curve in totally laparoscopic surgery for gastric cancer,7,8 and these studies show that experienced surgeons for laparoscopic surgery have obtained stable surgical outcomes for over twenty cases after initial totally laparoscopic surgery. This finding suggests that a relatively small number of cases are required to overcome the learning curve for this technique, as compared to that for laparoscopy-assisted surgery, among surgeons experienced with open surgery. Furthermore, the other article in this issue suggests the possibility of totally laparoscopic surgery in lower-volume centers.9

The editors feel that this issue of the Journal of Gastric Cancer will provide help to surgeons who seek to launch the application of totally laparoscopic surgery for gastric cancer.