[Laparoscopic surgery of the stomach: state of the art]

Over the past 10 years laparoscopy has been used for the staging of gastric cancer. It has also been used over the past decade for cancer resections, mainly stage I. In addition, it can be used for palliation in advanced stages. We have reviewed the main papers published in the English literature with a view to assessing the validity of laparoscopy in the staging of gastric cancer and in curative resections for cancer. Several studies published in the last 5 years have demonstrated the utility of laparoscopy in the staging of gastric cancer--mainly T3 and T4--and of cancer of the oesophagogastric junction. Laparoscopy can reduce the numbers of useless laparotomies performed and may be useful in selecting patients for neoadjuvant therapy. A number of studies have demonstrated the feasibility of laparoscopic gastric resections, mainly in stage I cancer. The advantages it affords consist above all in less postoperative pain and a quicker recovery. Laparoscopy, then, is useful in the staging of gastric cancer and in cancer of the oesophagogastric junction, mainly because it brings down the number of pointless laparotomies. More debatable is the issue of gastric resection for cancer, because of the low prevalence of early gastric cancer in Western countries.