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KMID : 1035920190220010003
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Journal of Minimally Invasive Surgery
2019 Volume.22 No. 1 p.3 ~ p.4
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Is Laparoscopic Approach Also Safe for the Treatment of Remnant Gastric Cancer?
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Song Kyo-Young
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Abstract
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The most important advantages of laparoscopic gastrectomy are the minimal invasiveness, including less postoperative pain, shorter recovery, and minimal complications. A laparoscopic distal gastrectomy is accepted widely as a standard treatment for gastric cancer. On the other hand, a laparoscopic total gastrectomy has not been popularized as a distal gastrectomy because of the complexity of a lymph node dissection and the diversity of reconstruction. In terms of laparoscopic surgery for a remnant gastrectomy, there are three key points, which are critical for safe operation: adequate lymph node dissection, meticulous adhesiolysis, and reconstruction. After radical surgery for gastric cancer, the intra-abdominal condition is greatly changed. In addition, the lymphatic anatomy around the stomach is broken and surgeons should be aware of a newly developed lymphatic system to perform adequate node dissection. An esophago-jejunal reconstruction is at risk of leakage. Until evidence that is more concrete can be obtained, experienced surgeons should consider the laparoscopic approach.
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KEYWORD
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Gastrectomy, Gastric cancer, Gastric remnant, Laparoscopy, Lymph node dissection
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