International Journal of Clinical Case Reports 2024, Vol.14, No.4, 221-229 http://medscipublisher.com/index.php/ijccr 222 2 Current Surgical Techniques in Gastric Cancer Resection 2.1 Open gastrectomy: indications and surgical outcomes Open gastrectomy remains the traditional approach for treating both early and advanced gastric cancers. It is particularly indicated for tumors that are located in areas where minimally invasive techniques might be difficult to perform or when the tumor has advanced to a stage requiring extensive dissection. This approach provides a clear view of the surgical field and allows for complete removal of the tumor with adequate margins and lymph node dissection. Studies indicate that open gastrectomy results in good oncological outcomes, especially when performed in high-volume centers. However, it is associated with longer recovery times and a higher complication rate compared to minimally invasive approaches (Coburn et al., 2018). 2.2 Laparoscopic gastrectomy: advancements and benefits Laparoscopic gastrectomy has revolutionized gastric cancer surgery, particularly for early-stage disease. This minimally invasive technique offers benefits such as reduced blood loss, shorter hospital stays, and quicker recovery times. Several studies have shown that laparoscopic gastrectomy offers comparable oncological outcomes to open gastrectomy while providing enhanced postoperative recovery and quality of life. Its feasibility for advanced cases is still being evaluated, but early data suggest that, when combined with perioperative chemotherapy, it may be an effective alternative for certain patients (Figure 1) (Straatman et al., 2015). Figure 1 Overview of placement of trocars in minimally invasive gastrectomy (Adopted from Straatman et al., 2015). Image caption: 1: laparoscope placement, 2: Nathanson Hook Liver Retractor; 3 and 4: additional instruments; 5: the incision (±5 to 6 cm) is performed in order to allow for retrieval of the specimen,and the wound is protected with an Alexis® wound protector, Applied Medical Resources Corp, Rancho Santa Margarita, California, USA. Dotted line portrays open gastrectomy (Adopted from Straatman et al., 2015). 2.3 Robotic-assisted gastrectomy: technical innovations and clinical impact Robotic-assisted gastrectomy represents the latest advancement in gastric cancer surgery, offering enhanced precision through improved visualization and dexterity. This technology has been particularly beneficial in performing complex procedures, such as total gastrectomies or extensive lymphadenectomies, which are more challenging in traditional laparoscopic surgeries. Robotic surgery minimizes the limitations of laparoscopic instruments, such as restricted movement, and provides better access to hard-to-reach areas. The clinical outcomes, including reduced postoperative pain and quicker recovery times, are promising, although the high cost and longer operative times remain challenges (Caruso et al., 2016).
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