Current trends of laparoscopic gastrectomy for gastric cancer in Japan

Laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy (LADG), is widely accepted for the treatment of early gastric cancer with a risk of lymph node metastasis. In Japan, a nationwide survey conducted by the Japan Society of Endoscopic Surgery has shown that the number of laparoscopic gastrectomies is gradually increasing. So far, the following advantages of laparoscopic surgery for the treatment of gastric cancer have been well documented: favorable clinical course after operation, pulmonary function and immune response. A retrospective multicenter study in Japan has shown that the short-term outcomes of laparoscopic gastrectomy are beneficial and that the long-term outcomes are the same as those for open surgery. Recently, the Gastric Cancer Surgical Study Group of the Japan Clinical Oncology Group conducted a multi-institutional, phase II trial (JCOG0703) to evaluate the safety of LADG for clinical stage I gastric cancer. In the future, laparoscopic surgeons will need to design and implement education and training systems for standard laparoscopic procedures, evaluate clinical outcomes through multicenter randomized controlled trials and clarify the oncological aspects of laparoscopic surgery in basic studies.