Journal of Surgical Oncology

REVIEW

Minimally Invasive Approaches for Gastric Cancer—Korean Experience HAN-KWANG YANG,MD,PhD,1,2*YUN-SUHK SUH,MD,BS,1AND HYUK-JOON LEE,MD,PhD1,2

1Department of Surgery,Seoul National University College of Medicine,Seoul,Korea

2Cancer Research Institute,Seoul National University College of Medicine,Seoul,Korea

Laparoscopic surgery in Korea increased rapidly because of the early detection of gastric cancer by the development of diagnostic tools and nationwide screening.The Korean Laparoscopic Gastrointestinal Surgery Study Group(KLASS group)played a leading role in various projects related with minimally invasive surgery.The justi?cation of minimally invasive procedures including robotic surgery,sentinel-node biopsy,or single-port surgery/Natural Ori?ce Transluminal Endoscopic Surgery(NOTES)must be predetermined by the clinical trial before a wide application,and the medical industry as well as surgeons should have great responsibility.

J.Surg.Oncol.?2012Wiley Periodicals,Inc.

K EY W ORDS:minimally invasive;stomach neoplasm;laparoscopy;gastrectomy;surgical procedures

INTRODUCTION

The advantages of minimally invasive approaches are less postoper-ative pain,better cosmesis,less in?ammatory reaction,rapid recovery of bowel function,well-preserved immune function,short hospital stay,and a rapid return to normal social http://www.doczj.com/doc/5f5779e7f524ccbff1218495.htmlparoscopic surgery in Korea increased rapidly after2001because the development of diagnostic tools and nationwide mass health screening increased the detection of early gastric cancer(28.6%in1995,47.4%in2004,and 57.7%in2009)[1,2].In addition,medical insurance began to cover laparoscopic surgery for gastric adenocarcinoma since2006.Conse-quently the number of laparoscopic surgery among all gastric cancer surgeries increased from740(6.6%)in2004to3,783(25.8%)in2009 [2,3].The cumulative number of laparoscopic gastric cancer surgeries from1995to2009was estimated at about14,731[2].

LAPAROSCOPIC SURGERY FOR

GASTRIC CANCER

Early Period:1994–2000

Laparoscopic surgery in Korea was introduced via the Internation-al Union Againt Cancer(UICC)Seoul Workshop in Seoul National University Hospital(SNUH)on Gastric cancer treatment in1994[4]. First domestic report of laparoscopic gastrointestinal surgery was reported in1995[5].Before2000,laparoscopic surgery in Korea was performed by only a few surgeons.However,as a treatment option for early gastric cancer,laparoscopy-assisted distal gastrecto-my(LADG)was?rst reported in1996and other laparoscopy-assisted procedures including intragastric approach or wedge resec-tion were also reported[6–10].For the active discussion about lapa-roscopic surgery,SNUH Laparoscopic Surgery Workshop started to be held annually in SNUH from2000.This symposium was com-bined with‘‘wet animal lab’’using swine models for the reconcilia-tion between theory and practicalities.

Developing Period:2001–2005

From2001,the information committee of the Korean Gastric Cancer Association started to analyze nationwide survey of laparoscopic gastric surgery in Korea,and the Korean Laparoscopic Gastrointestinal Surgery Study Group(KLASS group)has reported a regular survey of laparoscopic gastric surgeries from2004[1,11].In terms of the type of gastrectomy,LADG is the most common proce-dure(629cases in2004)[11].The number of laparoscopy-assisted total gastrectomy(LATG)was rapidly increasing from2004(2cases in2001,20cases in2003,109cases in2004)[1,11].On the con-trary,laparoscopy-assisted proximal gastrectomy(LAPG)or laparos-copy-assisted pylorus-preserving gastrectomy(LAPPG)was rarely conducted(11cases for LAPG,1case for LAPPG in2004)[11]. Considering overall gastrectomies including open gastrectomy(OG), pylorus preserving gastrectomy(PPG)was still performed for only 86cases(0.6%)in2009[2].This result is quite different from that of Japan where25–30%of gastric cancer was performed by LAPPG among all laparoscopy-assisted gastrectomies(LAG)[12,13].

At developing period of laparoscopic gastric surgery in Korea, several institutes reported their experience of laparoscopic surgery for gastric cancer.Hand-assisted laparoscopic surgery(HALS)was often reported,but the number of that procedure was gradually de-creased[14,15].On the other hand,the experience of LADG with lymph node dissection,diverse wedge resection techniques,or lapa-roscopic ultrasound were also introduced[16–20].

Based on the phase II study about the technical feasibility and surgical safety,LAG could be performed with acceptable morbidity and mortality(3.1–20.3%of postoperative complication rates and 0.0–0.7%of30-day mortality rate)[21–23].In terms of oncological safety,LAG was reported as a safe procedure for early gastric cancer with mean40–50.1retrieved lymph nodes,even though that EGC had lymph node metastasis[21,24].Regarding the learning curve, Con?icts of interest:None.

*Correspondence to:Han-Kwang Yang,MD,PhD,Department of Surgery and Cancer Research Institute,Seoul National University College of Medicine,Seoul,Korea101Daehang-Ro,Jongno-gu,Seoul110-744, Korea.Fax:t82-2-3672-0047.E-mail:hkyang@snu.ac.kr

Received9May2012;Accepted14May2012

DOI10.1002/jso.23179

Published online in Wiley Online Library

(http://www.doczj.com/doc/5f5779e7f524ccbff1218495.html).