Future of Gastric Cancer Surgery

Speaker

Takeshi SANO Hospital Director Gastroenterological Surgery Cancer Institute Hospital of JFCR, Japan

Takeshi SANO
Hospital Director
Gastroenterological Surgery
Cancer Institute Hospital of JFCR, Japan

Talk Abstract

Considering that Helicobacter pylori has inhabited the human stomach for tens of thousands of years, gastric cancer can be said to be one of the oldest malignancies in humans. However, the first successful gastrectomy for cancer was performed only 143 years ago. Recently, H. pylori has been rapidly disappearing from the human stomach, and with this change, gastric cancer itself is also transforming. At this historical turning point, how should we, as surgeons, confront gastric cancer?

The history of gastric cancer surgery is essentially the history of lymph node dissection. Since surgery is powerless against numerous peritoneal or liver metastases, the surgical target naturally focused on the complete removal of the primary lesion and lymph node metastasis. With the advancement of anesthesiology, gastric cancer surgery continued to expand, but recent clinical trials have shown that extended surgery does not improve prognosis and may even worsen it. It has now been recognized that gastric cancer surgery should be performed safely and minimally invasively within an appropriate range.

Laparoscopic surgery, a revolutionary technique, has been introduced for gastric cancer and has further evolved into robotic surgery. In East Asian countries, large-scale clinical trials have built evidence for the benefits of this new technology.

For early gastric cancer, function-preserving surgery is becoming mainstream, while for locally advanced cancer, minimally invasive surgery combined with remarkably advancing chemotherapy is becoming the standard. In the future, as genome analysis progresses and the "individuality" of each gastric cancer is elucidated, personalized treatment combining appropriate resection and various drug options, including molecular-targeted agents, will be required. Surgeons will need to master new technologies as part of a multidisciplinary treatment approach.