Laparoscopic surgery for gastric cancer: comparative-effectiveness research and future trends

Abstract

Research and technology have revolutionized surgery. Patient-oriented scientific efforts drive biomedical science advances. Improving patient’s outcomes dramatically, minimally invasive approaches represent a rapidly growing field. However, high-quality evidence for incorporating new medical devices, technology and surgical techniques into public healthcare with safety, efficiency and considering cost–effectiveness ana lysis is required [1]. In the beginning of the new decade, laparoscopic surgery in the multidisciplinary and multimodal treatment of solid tumors will probably experience a boom in clinical practice. In a 2020 vision, a progressive increase in the clinical use rates of laparoscopic and robotic-assisted tumor resections can be expected. We discuss here the perspectives, questions, limitations, potential harms in individual patients and public health, and challenges of laparoscopic gastrectomy for gastric cancer. Among gastrointestinal cancers, tumors located in the colorectum and stomach are the most common, with approximately 1.9 million new cases each year worldwide, resulting in high mortality rates [2]. Over the past few decades, open surgery has been standard. Adequate resection of the primary tumor and of regional lymph nodes resulting in complete resection with no macroscopic or microscopic evidence of residual tumor (R0 resection) has been established as standard approach either before or after adjuvant chemotherapy and radiotherapy. Is laparoscopic R0 gastrectomy feasible, safe and equally effective, compared with open surgery? Patient-friendly minimal invasive approaches in the treatment of gastrointestinal cancer include endoscopic submucosal dissection for very early, small-size tumors and laparoscopic or robotic resection for more advanced, larger tumors. Any new development or innovation, including medical devices, surgical techniques, drugs and biomarkers, requires rigorous evaluation and validation before it can be approved for wide clinical use. For example, it is now recommended by the editors of high-impact journals, such as Nature, that scientists straddling the boundary between bench and bedside must conduct and report their research with the rigor that each individual community expects [3].