Laparoscopic Surgery for Gastric Cancer: Distal Subtotal Gastrectomy with D2 Lymph Node Dissection

Abstract

The outcomes of treatment for gastric cancer in Japan have improved markedly as a result of early detection and extensive radical surgery. To date, the Japanese Gastric Cancer Association (JGCA) has recommended that non-early, potentially curable gastric cancers should be treated by D2 lymphadenectomy, and defined standard gastrectomy, which is the principal surgical procedure performed with curative intent, as resection of not less than two-thirds of the stomach with a D2 lymph node dissection. Laparoscopic surgery was launched in the early 1990s. At that time, most laparoscopic surgeons applied laparoscopic surgery, using its minimally invasive nature, to less extended surgery. However, we assumed from the beginning that laparoscopic surgery should be suitable for meticulous dissection using laparoscopically enhanced anatomy and improved hemostasis via pneumoperitoneal pressure, and since the mid-1990s, we have been doing totally laparoscopic D2 gastrectomy with intracorporeal anastomosis using linear staplers as the standard treatment for operable patients with resectable gastric cancer. In this article, we present technical aspects of totally laparoscopic D2 distal gastrectomy based on our experience.