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Treatment And Management of Laparoscopic Gastrectomy

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Introduction

Gastric cancer is a disease with worldwide relevance. Currently, it is known as the second cause of death related to cancer and the fourth most frequent neoplasm worldwide. Despite the decrease in incidence and mortality, it remains a globally affected pathology, with a higher prevalence. Laparoscopic Trainer Box.

During their internship in laparoscopic technique, many of them have not received practical training with Laparoscopic Trainer Box.

Laparoscopic gastrectomy first introduces in 1994, where a laparoscopic distal gastrectomy with reconstruction performs for early gastric cancer. Since then, the experience in laparoscopic gastrectomy has been increasing, mainly in Eastern countries where gastric adenocarcinoma is more frequent.

Difficulties Gastric Cancer Treatment

Gastric cancer is the second leading cause of cancer-related death and the fourth most common neoplasm worldwide. Multiple studies, mainly Asian, have validated the safety and short- and long-term oncological results of laparoscopic gastrectomy. The indications for this procedure limits to early and locally advanced gastric cancer, considering that lymphatic dissection is technically very difficult.

Multiple factors impact the outcome of this procedure: specific to the surgeon, the procedure, and the patient. It attributes greater satisfaction and better quality of life in patients.

Limitations Of Conventional Laparoscopy

Many articles have validated the safety and short- and long-term oncological results of this type of approach. Conventional laparoscopy presents various difficulties for surgeons, including two-dimensional vision, increased physiological tremor, limitation in tissue manipulation, and ergonomic discomfort.

Adequate Surgical Skills

These characteristics have limited and created difficulty in the application of laparoscopy for major abdominal surgeries, which require specific surgical skills. To adequately determine the patients who are candidates for this procedure, the different indications must be clear.

Laparoscopic Management for Gastric Cancer

Now, the indications for laparoscopic gastrectomy limits to early and locally advanced gastric cancer. Considering that the lymphatic dissection presents a lot of technical difficulty. Therefore, this review aims to present updated evidence on the laparoscopic management of early and locally advanced gastric cancer, the factors that takes into consideration for patient selection, review of the surgical technique and the results.

Methods in Laparoscopic Gastrectomy

The search for the review of this topic carries out in the databases, under the phrases Laparoscopic Gastrectomy and Gastric Cancer. Original articles or studies and topic reviews includes. The inclusion criteria were publications between 2014 and 2020, preferably taking articles, countries at the forefront of this topic. 21 articles reviews that met the criteria and contained the necessary information for the development of this review to meet the established objective.

Early Gastric Cancer

Early gastric cancer defines as a tumor limited to the mucosa and submucosa, regardless of nodal status. This type of gastric cancer is of special importance in Asia since it represents 25-50% of all gastric cancers, since they have screening programs. The main studies carried out in Asia regarding early-stage laparoscopic management will discusses below.

Results obtained

The cohort study compared the outcomes of 3630 patients with early gastric cancer treated with laparoscopic gastrectomy versus open surgery from 2006 to 2012. In this study, there was no difference in 5-year survival (97.1% in laparoscopic gastrectomy vs. 96.6% in open gastrectomy), recurrence-free survival at 3 years (97.7% vs. 97.4%, respectively), or local recurrence rate (2.3% vs. 2.4% % respectively). Use of Simulations is significant choice with Laparoscopic Trainer Box.

In, a multicenter, randomized controlled study, conducts, which compared more than 1400 patients with early gastric cancer, assigned to laparoscopic vs open distal gastrectomy between 2006 and 2010. As a result, it calculates that the overall complication rate and surgical wound infection lower in the laparoscopic gastrectomy group.

Results Of Study

A similar result obtains in the rates of major intra-abdominal complications and perioperative mortality, as well as in 5-year survival. Another study evaluated 921 patients with stage I gastric cancer located in the body or distal stomach assigned to laparoscopic gastrectomy vs open surgery from 2010 to 2013.

Conclusion

The laparoscopic approach required more surgical time but had less blood loss. There were no differences in short-term morbidity, nor in the mortality rate. New studies include a multicenter and prospective study. This compared 160 patients with stage I gastric cancer, from 19 institutions, from 2012 to 2014.

Where postoperative morbidity and mortality reached rates of 20.6% and 0.6% respectively. This do not differ significantly from previous morbidity studies for open gastrectomy (18%).

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