Surgery for locally advanced gastric cancer by open approach

In Japan, standard treatment for early gastric cancer not indicated for ESD remains gastrectomy with D1+ dissection, which provides excessive safety margin for most patients. The background philosophy is that there should be no room for concern in the treatment of a disease where recurrence through suboptimal surgery is certain to cause regret for those involved. The high incidence of early gastric cancer that are nevertheless indicated for decent lymphadenectomy provided us with ample opportunity to train ourselves for the laparoscopic approach. On the other hand, the current standard for resection of advanced gastric cancer is no more than D2 dissection, which is not really a far cry from D1+. Moreover, splenectomy and bursectomy, once essential components of D2 dissection for selected patients, are now being tested in randomized trials and may lose their relevance pending the results, further simplifying surgery for advanced cancer. However, the techniques to perform pancreatico-splenectomy or conduct extended lymphadenectomy, particularly after neoadjuvant chemotherapy, will still be needed in order to cope with cancers with bulky lymph nodes and invasion to the adjacent structures. Thus, videos of open surgery to dissect locally advanced cancer using states of the arts instruments will be presented.