Page 38 - Read Online

Shimada et al. Mini-invasive Surg 2019;3:7 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.78

Review Open Access

Laparoscopic lymph nodes dissection for
advanced gastric cancer: the current status and the
perspective

Masanari Shimada, Susumu Amaya, Yoshinori Munemoto, Takeshi Mitsui

Department of Surgery, Fukui-ken Saiseikai Hospital, Fukui 918-8503, Japan.
Correspondence to: Dr. Masanari Shimada, Department of Surgery, Fukui-ken Saiseikai Hospital, Wadanaka Funabashi 7-1,
Fukui 918-8503, Japan. E-mail: masanari.shimada@gmail.com
How to cite this article: Shimada M, Amaya S, Munemoto Y, Mitsui T. Laparoscopic lymph nodes dissection for advanced gastric
cancer: the current status and the perspective. Mini-invasive Surg 2019;3:7. http://dx.doi.org/10.20517/2574-1225.2018.78
Received: 19 Dec 2018 First Decision: 18 Feb 2019 Revised: 25 Feb 2019 Accepted: 26 Feb 2019 Published: 27 Mar 2019

Science Editor: Tetsu Fukunaga Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
The laparoscopic gastrectomy (LG) with D2 lymph node dissection (LND) for advanced gastric cancer (AGC) have been
widely done. However, the applicability to more advanced disease is still under debate. Actually, there are a lot of technical
demands against D2 LND for AGC, e.g., total omentectomy, splenic hilar node dissection, and the management for bulky
lymph nodes, etc. Recently, extensive research has been gradually performed in the field of LG for AGC and demonstrated
that LG for AGC is a safe and feasible procedure with better short-term outcomes compared with open gastrectomy. Also,
large-scaled phase III trials are ongoing, and their long-term outcomes are awaited the publication in the near future.
LG with D2 LND by expert surgeons under the cautious indications could be acceptable treatment for locally AGC. On
the other hand, we should keep searching for solutions to the technical or oncological issues, and long-term outcome of
phase III study should be warranted for standard treatment. Robotic surgery, LG following neoadjuvant chemotherapy, or
conversion therapy using LG for several stage IV patients may help us clear the technical hurdles, and may show survival
advantages in the future.

Keywords: Laparoscopic gastrectomy, advanced gastric cancer, lymph node dissection, distal gastrectomy, total
gastrectomy

INTRODUCTION
Laparoscopic gastrectomy (LG) for gastric cancer has been popular rapidly with the improvement of
technique and the progress of surgical devices. In the latest Gastric Cancer Treatment Guidelines 2018 (ver.5)
[1]
published by Japanese Gastric Cancer Association , laparoscopic distal gastrectomy (LDG) for clinical
© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.misjournal.net