Current evidence and technical challenges for laparoscopic surgery for advanced gastric cancer

The number of minimally invasive surgeries for advanced gastric cancer has been increasing recently. Most of the reports are from East Asian countries, and results of randomized controlled trials have been published from Japan (JLSSG0901), China (CLASS-01), and Korea (KLASS-02).
Patients with cT2-4a advanced gastric cancer were eligible, and the number of patients recruited in JLSSG0901, CLASS-01, and KLASS-02 were 507, 1056, and 1050, respectively.
In JLSSG0901, 5-year recurrence free survival was set as a primary endpoint, and the hazard ratio (90% C.I.) was reported to be 0.9556 (0.7226 – 1.2637). The Uupper limit of 90% C.I. was lower than the threshold value of 1.31, and thus the null hypothesis was rejected. CLASS-01 in which 3-year disease free survival was adopted as a primary endpoint, and KLASS-02 with 3-year recurrence free survival being a primary endpoint, also satisfactorily demonstrated the non-inferiority of laparoscopic gastrectomy to open gastrectomy in terms of long-term survival outcomes. As three randomized controlled trials conducted in different countries clearly demonstrated the potential benefit of laparoscopic gastrectomy, it has been accepted as a treatment option for advanced gastric cancer as well as for early gastric cancer. Robot- assisted gastrectomy, another form of minimally invasive surgeryies, has many advantages, including articulated devices, tremor cancelling function, and magnified 3-degree view, over laparoscopic gastrectomy, and will also be a treatment option for advanced gastric cancer.