Advanced gastric cancer: is laparoscopic gastrectomy safe?

摘要: As experience with laparoscopically assisted distal gastrectomy (LADG) for early gastric cancer substantially increased, particularly in Korea and Japan [1], it was expected that the next step would be laparoscopic treatment of advanced cancer. Indeed, unsurprisingly, Hwang et al. [2] reported on LADG a recent issue Surgical Endoscopy. However, evidence surgery’s safety terms oncologic outcomes still is lacking. Nevertheless, several large randomized controlled trials metaanalyses have demonstrated surgery more patient-friendly procedure than open colectomy, offering better postoperative quality life having no negative effect recurrence or survival patients stages colon [3]. These findings positive results retrospective studies investigating justify current study’s evaluation LADG’s efficacy [1]. Both D2 lymphadenectomy require surgeon’s skill safe effective resectable [4]. Korea, country high incidence cancer, has long-term standardized extended perhaps largest worldwide. from an academic Department Surgery Seoul performed 45 3 years (2004–2007), then compared their clinical pathologic data 83 who underwent (ODG) during this same period. Although operation time longer ODG, there significant difference morbidity mortality between two groups. The mean number resected lymph nodes similar groups (35 vs 38 ODG). During follow-up period 23 months, six stage 3a/3b disease group experienced This small study had limitations weakness. too short conclusions to drawn, presented by authors are promising encourage phase 2 assess Recently, confirmatory excellent indirectly utility [5, 6]. In West, lacking, controversy exists potential benefit [7–10]. Data scarce determine whether perioperative, preoperative only, chemotherapy should added limited D1 [11–13]. Given important role locoregional tumor control not only recurrence-free but also overall solid tumors, including breast [14] indicate every effort made prevent local nodal [15–17]. Can worsen cancer? Despite skepticism T. Liakakos (&) E. P. Misiakos A. Macheras Third Department, University Athens, Greece e-mail: theodlia@otenet.gr