关键词: 腹腔镜, 胃癌, 淋巴结清扫, 消化道重建, 手术入路

Abstract:

Controversies and consensus of laparoscopic surgery for gastric cancer        ZANG Lu, MA Jun-jun, ZHENG Min-hua. Department of Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
Correspongding author：ZANG Lu, E-mail: zanglu@yeah.net
Abstract    Laparoscopic gastrectomy has been popularized with the expanding indication and decreasing complication since the development of laparoscopic surgical techniques in the past 20 years. The controversies and consensus also coexist at present.(1) Indication of laparoscopic surgery for gastric cancer: Laparoscopic gastrectomy for early gastric cancer is accepted all over the world. For locally advanced gastric cancer, laparoscopic gastrectomy with D2 dissection is still under debate. (2)Lymphadenectomy and bursectomy:D2 lymph node dissection margin in laparoscopic distal gastrectomy has been defined by a Chinese expert consensus in terms of quality control of laparoscopic radical gastrectomy for gastric cancer. Bursectomy is not recommended as standard procedure in cT3 or cT4a gastric cancer based on the results of JCOG1001. (3)Totally laparoscopic reconstruction: Totally laparoscopic reconstruction  provides a better and larger surgical scene compared to small incision assisted surgery. The whole procedure of anastomosis is monitored clearly by laparoscopy, without any over traction of tissue. (4)Position and approach: Left-side position is the first choice in China, which is suitable for most laparoscopic gastrectomy, and needs good teamwork. It is superior to right-side position especially in D2 dissection for local advanced gastric cancer when dissection of greater omentum and anterior lobe of transverse mesocolon is needed.

Key words: laparoscope, gastric cancer, lymphadenectomy, digestive tract reconstruction, surgical approach