Current status of endoscopic surgery for upper gastrointestinal cancer in Japan

Laparoscopic and/or thoracoscopic surgery represents an important intermediate option between endoscopic resection and open surgery for patients with upper gastrointestinal (GI) cancer. Nowadays many patients with gastric cancer are currently treated by advanced laparoscopic gastrectomy worldwide. Also esophagectomy through a thoracoscopic approach for esophageal cancer is attracting attention as a minimally invasive esophagectomy. These advanced endoscopic surgeries are believed to contribute to better cosmesis and early postoperative recovery. To date, there has been a very limited number of prospective multicenter trials to verify the benefits of endoscopic surgery for upper GI cancer. JCOG0912 showed the clinical equivalency of laparoscopic gastrectomy to the conventional open gastrectomy in terms of postoperative complications, and laparoscopic gastrectomy was superior to open surgery regarding early recovery of postoperative wound pain and bowel functions. Also our study using the National Clinical Database suggested that minimally invasive esophagectomy is comparable with conventional open esophagectomy in terms of short-term outcome after surgery and is regarded as a desirable surgical option for patients with esophageal cancer.There have been several ongoing randomized controlled trials in Japan including JCOG0912, JLSSG0901 for gastric cancer and JCOG1409 for esophageal cancer, which would evaluate the long-term outcomes of endoscopic surgery in comparison with open surgery. If those prospective studies would indicate the oncological benefits of endoscopic surgery could truly become the standard care for patients with upper GI cancer.