Can Gastric Cancer Be Treated with Minimally Invasive Surgery?

Understanding Minimally Invasive Surgery for Gastric Cancer

In clinical practice, many patients often ask: “Can I undergo minimally invasive surgery for my condition?” “Does opening the abdomen ensure a more thorough removal?” “Is minimally invasive surgery the same as endoscopic removal?” These questions, while seemingly basic to medical professionals, highlight the information gap that exists between doctors and patients. As healthcare providers, it's important to recognize that patients and their families need time to understand complex medical topics. Therefore, patience and clear communication are essential in helping them make informed decisions.

Let's explore the basics of minimally invasive treatment for gastric cancer.

What Is Minimally Invasive Surgery for Gastric Cancer?

Minimally invasive surgery for gastric cancer typically refers to laparoscopic radical gastrectomy. During this procedure, the surgeon frees the stomach and performs lymph node dissection under the guidance of a laparoscope. Digestive reconstruction can be completed either through a small auxiliary incision or entirely under laparoscopic visualization.

Compared to traditional open surgery, which requires a large incision of up to 25cm, laparoscopic techniques significantly reduce abdominal wall trauma and minimize fluid evaporation caused by prolonged organ exposure. The magnification provided by the laparoscope allows for more precise dissection and clearer anatomical visualization, resulting in less intraoperative damage and reduced blood loss. This leads to faster postoperative recovery. However, laparoscopic surgery may take longer and carries risks associated with pneumoperitoneum. In cases where the tumor is large, invades nearby organs, or involves fused lymph nodes, laparoscopic approaches may not be suitable.

To put it simply, choosing between open and minimally invasive surgery for gastric cancer is like choosing between eating with your hands or using chopsticks—both aim to achieve the same goal, but through different methods. Current clinical evidence suggests that both approaches offer similar long-term safety and efficacy, with laparoscopic surgery offering faster recovery. Overall, minimally invasive surgery represents the future of gastric cancer treatment.

Can Minimally Invasive Surgery Achieve Complete Tumor Removal?

Some patients and families believe that open surgery allows for better visibility and thus more complete tumor removal. However, both open and laparoscopic surgeries follow the same guidelines for gastric resection and lymph node dissection. The completeness of lymph node clearance is determined by anatomical landmarks and lymphatic group classifications—not simply by what is visible to the naked eye.

In fact, due to the enhanced visualization provided by the laparoscope, small, abnormal lymph nodes can be more easily identified. The idea that a larger incision equals better visibility and more complete removal is a misconception. Laparoscopic surgery can be just as effective, if not more so, in achieving a complete resection.

Is Minimally Invasive Surgery the Same as Endoscopic Resection?

It's important to distinguish between laparoscopic surgery and endoscopic resection. Endoscopic removal is only suitable for certain early-stage gastric cancers that are well-differentiated, small in size, and confined to the mucosa or submucosa. Although the indications for endoscopic treatment have expanded in recent years, they remain distinct from those of laparoscopic surgery.

Guidelines such as the Japanese Gastric Cancer Treatment Guidelines and the Chinese Consensus on Early Gastric Cancer Screening and Endoscopic Management provide detailed criteria for endoscopic treatment eligibility.

Is Minimally Invasive Surgery Suitable for All Gastric Cancer Patients?

There is ongoing debate regarding the indications for laparoscopic radical gastrectomy. According to the Japanese Gastric Cancer Guidelines, laparoscopic surgery is now a standard treatment for early-stage (clinical stage I) gastric cancer. However, for advanced cases, its application remains limited.

In recent years, the use of laparoscopic gastric surgery has grown rapidly in China, with even some local hospitals now capable of performing these procedures. Based on the 2016 Chinese Laparoscopic Gastrectomy Guidelines, the indications have expanded to include clinical stages I, II, and IIIa. Nevertheless, for tumors that are large, invasive, or associated with extensive lymph node involvement, laparoscopic surgery should be approached with caution. Decisions should be based on established clinical guidelines and the surgeon's experience to ensure the best possible outcome for the patient.