Role of laparoscopic resection in gastric cancer treatment

Increasingly, laparoscopic resection has been used in treatment of early gastric cancer. Laparoscopic approaches that have been described for the treatment of early gastric cancer include: 1) Laparoscopic intragastric mucosal resections; 2) Laparoscopic wedge resection; and 3) Laparoscopic assisted gastrectomy. Furthermore, combining endoscopic resection with laparoscopic lymphadenectomy has also been investigated in cases where lymph node involvement cannot be excluded. In recent randomized controlled trials and meta-analyses, laparoscopic resection has been shown to improve post-operative pain, bleeding, length of hospitalization and cosmesis, when compared with open gastrectomy. Despite few studies reporting oncologic outcomes, indications have expanded from early gastric cancer to locally advanced gastric cancer in some centers. Multicenter randomized controlled trials are currently ongoing in Korea to evaluate oncologic outcome for laparoscopic resections for advanced gastric cancer (KLASS II trial). This chapter will discuss the role of laparoscopic resection in the treatment of gastric cancer.