Minimal-access surgery for gastric cancer in Japan.
Recently in Japan, endoscopic surgery has become focused on minimally invasive treatment for early gastric cancer. Endoscopic mucosal resection (EMR) is used to treat small mucosal gastric cancers <FONT FACE="MetaPress 6">&#104</FONT> 2 cm in size; however, total removal of the cancerous lesion in one session cannot be performed easily. Laparoscopic partial resection of the gastric wall is indicated for the same lesions as EMR, and we can achieve complete removal of cancer lesions more accurately. However, the extension of indication to depressed type cancer > 1 cm may carry the risk of lymph-node metastasis. Laparoscopic-assisted gastrectomy with lymph-node dissection is necessary for such lesions. It has many advantages over open gastrectomy in terms of postoperative pain, shorter febrile duration, reduced blood loss, earlier return to standing and earlier bowel movement. The wound is small and an almost-enclosed operation is possible. Furthermore, unlike other laparoscopic partial gastric resections, a major part of the regional lymph nodes can be extirpated, such as D1 + <FONT FACE="MetaPress 7">&#102</FONT>. Laparoscopic gastrectomy will play a greater role in the future, especially in replacing open surgery in cases of early gastric cancer.