Current role of minimally invasive approaches in the treatment of early gastric cancer

Abstract

Despite declining incidence, gastric cancer remains one of the most common cancers worldwide. Early detection in population-based screening programs has increased the number of cases of early gastric cancer, representing approximately 50% of newly detected gastric cancer cases in Asian countries. Endoscopic mucosal resection and endoscopic submucosal dissection have become the preferred therapeutic techniques in Japan and Korea for the treatment of early gastric cancer patients with a very low risk of lymph node metastasis. Laparoscopic and robotic resections for early gastric cancer, including function-preserving resections, have propagated through advances in technology and surgeon experience. The aim of this paper is to discuss the recent advances in minimally invasive approaches in the treatment of early gastric cancer.

Keywords: Endoscopy, Endoscopic resection, Endoscopic mucosal resection, Endoscopic submucosal dissection, Laparoscopic resection, Early gastric cancer, Pylorus preserving gastrectomy, Sentinel lymph node, Robotic gastrectomy

Core tip: Early gastric cancer (EGC) is associated with favorable prognosis and there have been many efforts made to minimize the invasiveness of resection. Curative minimally invasive approaches utilized for EGC include endoscopic, laparoscopic and robotic approaches, and sentinel lymph node biopsy. Endoscopic resections have been shown to be safe and effective treatments for carefully selected patients with EGC. In patients with EGC that are not candidates for endoscopic resection, laparoscopic and robotic resections allow for the appropriate curative resection and lymphadenectomy with the benefits of minimally invasive surgery, including improved pain, reduced blood loss, and shorter hospital length of stay.