[Gastric cancer: laparoscopic surgery and adjuvant chemotherapy]

Demands for minimally invasive treatments for early gastric cancer and improved efficacy of recent chemotherapy regimens for advanced gastric cancer have led to considerable changes in the modality of treatment Laparoscopic gastrectomy (LG) with lymph node dissection is widely performed as minimally invasive surgery. The number of LGs is increasing each year. However, the results of a nationwide questionnaire survey performed by the Japanese Society for Endoscopic Surgery indicated that there are some postoperative complications associated with gastrointestinal anastomosis. In this paper, we describe our experiences with a unique intracorporeal surgical technique to prevent such complications. Although adjuvant chemotherapy is frequently administered to patients with advanced gastric cancer, no randomized controlled trial (RCT) has confirmed the prognostic significance of adjuvant chemotherapy, although some meta-analyses have. Since a number of published reports demonstrated the survival benefit of chemosensitivity test-guided chemotherapy after surgery for gastric cancer, we propose a protocol to perform a RCT to clarify whether chemosensitivity tests in adjuvant chemotherapy for gastric cancer have a significant impact.