Laparoscopic Gastrectomy for Gastric Cancer
Gastrectomy is a complex operation and carries morbidity and mortality. Increased
experience with laparoscopic surgery has shown improved benefits – Minimal post-op pain,
quicker mobilisation and better cosmetic results have been shown from laparoscopic gastrectomies.
These features are advantageous only when curability can be guaranteed as compared
to that in open surgery and in some cases early gastric cancer is a good target for laparoscopic
gastrectomy because the nodal metastasis is rather limited and serosal surface is intact.
Recently, laparoscopic gastrectomies have been suggested for prophylactic
gastrectomy performed for hereditary diffuse gastric cancer.
Recent meta-analysis of early gastric cancer showed a superior post-operative
recovery in patients treated laparoscopically compared
with those treated using an open approach.
National oesophago-gastric cancer audit results in England and Wales between
April 2011 and March 2013 showed 287 gastrectomies were performed with
a minimally invasive approach out of a total of 1806 gastrectomies.
It is still 15.9% of total procedures.
The latest National oesophago-gastric cancer audit results in England and
Wales released in January 2016, are also supportive of the same findings where
minimally invasive gastrectomies represented only 14.5%.
A meta-analysis of 1161 patients showed fewer overall complications following
laparoscopic procedures as compared to open gastrectomy p<0.001.10
One non-randomised control trail by Adachi et al showed no significant
difference in complication rate between laparoscopic surgery and open surgery.
Laparoscopic gastrectomy obviously has a steep learning curve and performing
laparoscopic gastrectomies may initially take longer to do; one non-randomised control trial has
shown that open procedure was 55 minutes shorter than laparoscopic.
Surg Res Open J. 2016; 3(1): e3-e5. doi: 10.17140/SROJ-3-e002
