Intraoperative Management Tips for Avoiding Cancer Dissemination in Laparoscopic/Robotic Gastrectomy for Far Advanced Gastric Cancer

Peritoneal metastasis is the most common pattern of recurrence after radical surgery for advanced gastric cancers and is an important prognostic factor. This pattern of recurrence is thought to be due to free cancer cells in the peritoneal cavity that have detached from the tumor. The results of a multicenter randomized controlled trial comparing laparoscopic surgery with open surgery for advanced gastric cancer proved the non-inferiority of laparoscopic surgery over open surgery, and it is expected that the indication for laparoscopic surgery for advanced gastric cancer will be expanded in the future. However, the risk of cancer seeding due to tissue manipulation with laparoscopic forceps is a concern and best efforts should be made to prevent cancer seeding. To prevent cancer spread by forceps manipulation, it is extremely important not to touch the tumor. ICG navigation surgery, which is performed while accurately identifying the tumor site and lymphatic flow, can be performed without grasping the tumor. For large tumors such as type 4 gastric cancer, the patient is placed in a head-up position of about 15 degrees and the supra pancreatic lymph nodes are dissected in a gastric drooping position using gravity (Cranial approach). We believe that this approach allows us to dissect without touching the tumor. We will show a video of our cancer spraying prevention tips and tricks.