Laparoscopy-assisted proximal gastrectomy for early gastric cancer is an ugly duckling with unsolved concerns: oncological safety, late complications, and functional benefit

Excerpt

There are notable changes in that the proportion of early gastric cancer (EGC) and proximal gastric cancer has increased continuously during the past 20 years, from 24.8 % to nearly 50 % and from 5.3  to 14.0 %, respectively. Proximal EGC consists of 30.3 % of all proximal gastric cancer whereas distal EGC consists of 51.5 % of all distal gastric cancer [1‐3]. Accordingly, more and more surgeons are interested in laparoscopic gastrectomy for early gastric cancer. In proximal EGC and the concept of minimally invasive surgery, laparoscopy-assisted proximal gastrectomy (LAPG) is a theoretically better treatment option than others [i.e., open proximal gastrectomy, open total gastrectomy, and laparoscopy-assisted total gastrectomy (LATG)]. However, LAPG is not popular these days. Even including the open cases, proximal gastrectomy was performed in only 141 (1.0 %) patients in 2009 [2]. Proximal gastrectomy (PG) is not yet the standard treatment for patients with proximal early gastric cancer (EGC): it is still classified as an investigational treatment by the Japanese gastric cancer treatment guidelines [4]. The application of proximal gastrectomy to proximal EGC has been limited by the following three main concerns. The first is oncological concern, mainly focused on limited lymph node dissection; the second is late complications such as reflux esophagitis and anastomotic stricture, related to reconstruction methods; and the third is functional benefits. …