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Page 2 of 3 Fukunaga. Mini-invasive Surg 2019;3:26 I http://dx.doi.org/10.20517/2574-1225.2019.32

[6]
gastric cancer patients are reported and even fewer on older patients with AGC. Yuu et al. reported their
study to show elderly patients with AGC may benefit from laparoscopic distal gastrectomy (LDG).

[7]
More and more GI reconstruction can be performed intracorporeally especially in LDG. Ohmura et al.
reported a new reconstruction method named hemi-hand-sewn (HHS) technique. The HHS technique
combines linear stapler in posterior wall with hand sewn in anterior wall to create Billroth-I anastomosis.
They reported the better surgical results with HHS in comparison with extracorporeal total hand-sewn.
An optimal technique of digestive tract reconstruction after distal gastrectomy has not yet been consensus.
[8]
Zhang and Fukunaga describe the different Billroth-I reconstruction techniques that can be proposed
after total LDG. As mentioned by the authors, the ideal reconstruction should be not only for doctors
but also for patients. From the review article, readers can understand that the developing reconstruction
techniques covering from using hand-sewn anastomosis, circular stapler to linear stapler method, which
reflect the wisdom of the surgeon and the pursuit the minima invasive to patients.

There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric
[9]
cancer. TLTG usually needs higher laparoscopic techniques and longer learning process. Mazzola et al.
reported their results of TLTG. Their results showed TLTG was a feasible and safe option in the treatment
of gastric cancer.

Robotic surgery for gastric cancer is a relatively new research field. With high-resolution three-dimensional
and articulated devices, surgeons are able to perform difficult techniques more comfortably and
[10]
meticulously. Makuuchi et al. reviewed the development of surgical robotics, and describe the advantages
and disadvantages of robot gastrectomy for gastric cancer compared to LG. Although robotic gastrectomy
has theoretical advantages over LG, evidences are still lacking. Well-designed prospective randomized
controlled trials are needed and awaited to obtain conclusive results on this issue.

The incidence of EGJ cancer has shown an upward trend over the past several decades both in the West
[11]
[12]
and East . The management is challenging and there is no one-size-fit-all strategy . Siewert classification
is the standard classification for EGJ cancer. Surgery remains the fundamental treatment and a lot of detail
[13]
during surgery are reported recent years. Oo and Ahmed discussed the epidemiology, risk factors and the
[14]
management of EGJ tumors. Readers can get the general of this disease from this review article. Shibao et al.
introduced minimally invasive approach for EGJ cancer and listed evidences for various surgical strategies.
The authors discussed different technique according to Siewert type classification and listed advantages and
disadvantages.

Most studies focus on Siewert type II cancer, since it is considered the true EGJ tumor. The treatment for
[15]
type II cancer is still debated. Li and Zang focused on the surgical strategies for type II EGJ cancer in
recent year. The Ivor Lewis esophagectomy is the universally accepted technique to resect cancers situated
[16]
[17]
in the middle and distal esophagus and EGJ. de Pascale et al. and Parthasarathi et al. introduced their
experiences and results of totally minimally invasive Ivor Lewis (TMIIL) esophagectomy. Both of their
results showed better surgical outcomes in TMIL esophagectomy.

All of published articles are well written and meaningful. Articles published in this present special issue
have highlighted the outline of minimally invasive management of gastric and EGJ cancer. We can study
al lot from these studies. In the future, still a lot need to be researched and higher evidences are needed to
support the conclusions.