The era of laparoscopic surgery for gastric cancer: what is the present territory and what will be next?

Since its introduction, laparoscopic surgery has evolved from a new idea into a popular technique that is now the standard of care for many indications. In the treatment of gastric cancer, since Kitano et al. first reported a laparoscopic approach for gastric cancer resection in 1994 (1), laparoscopic techniques have become widely adopted by gastric cancer surgeons, beginning in Japan, Korea, and China, and now extending throughout the world. However, at the time laparoscopic techniques were being introduced, conservative surgeons expressed significant concerns about the use of laparoscopic techniques in the treatment of gastric cancer. In the past, many trials failed to show the benefit of chemotherapy for gastric cancer, thus it was considered to be a malignancy refractory to chemotherapy, making complete resection the only strategy for achieving a cure (2). As part of an attempt to completely remove all gastric cancer tumor cells, extended lymph node dissection was previously believed to provide survival benefits.