The number of elderly patients with gastric cancer operation is increasing, who were distinctly characterized by organ dysfunction, more complications, high risk of anesthesia, more postoperative complications and high mortality. Laparoscopy-assisted gastrectomy as a safe minimally invasive operation has been widely recognized and popular in clinical practice, but many contradictions and problems remain with its application in the elderly patients with gastric cancer. Thus this paper summarized the application of laparoscopy-assisted gastrectomy in elderly patients.
Gastrectomy ; methods ; Humans ; Laparoscopy ; Stomach Neoplasms ; surgery

Gastrectomy ; methods ; Humans ; Laparoscopy ; Stomach Neoplasms ; surgery

Gastrectomy ; methods ; Humans ; Laparoscopy ; Stomach Neoplasms ; surgery

Malignant or benign diseases of stomach are very common in China. The application of laparoscopy surgery in gastric diseases is a remarkable symbol of current gastric surgery. Laparoscopic assisted radical gastrectomy has gained widespread acceptance for the treatment of gastric cancer. Total laparoscopic radical gastrectomy, which means the gastric resection, lymph nodes dissection and gastrointestinal anastomosis are entirely performed in intracorporeally, is the inheritance and progression of laparoscopic assisted radical gastrectomy. However, controversy still exists regarding the risk and difficulty of intracorporeal anastomosis. In Asian countries including China, total laparoscopic radical gastrectomy has not been extensively performed yet. This review focuses on the issues related to intracorporeal gastrointestinal reconstruction in laparoscopic procedure, such as its history and current status, as well as the surgical technique and risk.
Anastomosis, Surgical ; methods ; Gastrectomy ; methods ; Humans ; Laparoscopy ; methods

In recent years, with the standardization and promotion of laparoscopic techniques, the use of laparoscopic radical total gastrectomy is increasing. The main difficult points of this technique focus on digestive tract reconstruction after total gastrectomy. Esophagojejunal Roux-en-Y anastomosis is the first choice in laparoscopic reconstruction. There are two main methods for totally laparoscopic total gastrectomy (TLTG). One is esophagojejunal end-to-side anastomosis using circular stapler, and the other is esophagojejunal side-to-side anastomosis using linear staplers. TLTG has its advantages in digestive tract reconstruction including better visualization high safety and less trauma, which makes it a safe, convenient and effective method for reconstruction.
Anastomosis, Roux-en-Y ; methods ; Gastrectomy ; methods ; Humans ; Laparoscopy ; methods

Recently, the detection of early gastric cancer (EGC) has increased because of the development of diagnostic techniques. Accordingly, new surgical procedures with minimal invasiveness including laparoscopic gastrectomy have been developed. Since the first laparoscopic-assisted distal gastrectomy (LADG) for EGC was performed, various new laparoscopic procedures, such as laparoscopic wedge resection (LWR) and intragastric mucosal resection (IGMR) have been developed for the treatment of EGC. Laparoscopic approaches to gastric cancer provide for minimal invasion, early recovery and decreased morbidity and mortality according to several short-term results. In the future, laparoscopic procedures for gastric cancer will be widely accepted in Korea, if the advantages of laparoscopic approaches are confirmed in randomized controlled trials of long-term outcomes.
English Abstract ; *Gastrectomy/methods ; Humans ; *Laparoscopy/methods ; Stomach Neoplasms/*surgery

With the development of laparoscopic skills and instruments,totally laparoscopic gastrectomy for gastric cancer has become widely used in the clinic,mainly including totally laparoscopic proximal gastric reconstruction,distal gastrectomy for gastric cancer and total gastrectomy. Digestive tract reconstruction is the key procedure of totally laparoscopic gastrectomy for gastric cancer. Totally laparoscopic surgery has less trauma and better visualization than reconstruction in a small incision. At present,feasibility and safety of totally laparoscopic gastrectomy for gastric cancer have been preliminarily confirmed. However,higher level of evidence is needed for the evaluation of long-term oncologic efficacy. In the future,it is possible for patients to best benefit from totally laparoscopic surgery with minimal trauma,safe anastomosis under the principle of radical resection of gastric cancer. The digestive tract reconstruction includes Delta anastomosis (Billroth I),Billroth II anastomosis,and gastrojejunal Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy (TLDG). Billroth I with delta anastomosis has strict indications in TLDG. Gastrojejunal Roux-en-Y anastomosis is now more popular. Billroth II with Braun anastomosis and uncut Roux-en-Y anastomosis is technically easier to carry out in TLDG than Roux-en-Y. Totally laparoscopic proximal gastric reconstruction includes esophagogastric stump anastomosis,esophagogastric tubular anastomosis and interposition jejunostomy. The digestive tract reconstruction includes anastomosis using linear stapler and circular stapler in totally laparoscopic total gastrectomy (TLTG). In order to better serve the clinic,we review the progress of different endoscopic anastomotic techniques and digestive tract reconstruction.
Anastomosis, Surgical ; methods ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Stomach Neoplasms ; surgery

A good team work including an excellent assistant is very important for laparoscopic radical gastrectomy, because of the complex anatomy around the stomach and the difficulty of extra-gastric lymphadenectomy. An assistant with expert cooperation can shorten the operation time, decrease bleeding, increase the smoothness of the operation, improve the quality of surgery. Growth of assistants requires time and case accumulation. Firstly they should understand their own tasks, perfect themselves in the use of laparoscopic instruments and operating skills. A good assistant should follow the lead of the surgeon and maintain good cooperation, and keep on learning in order to shorten the learning curve.
Gastrectomy ; methods ; Humans ; Laparoscopy ; methods ; Professional Competence ; Stomach Neoplasms ; surgery

Recently, total gastrectomy has been increasingly used for gastric cancer. However, it remains controversial as to the optimal technique for reconstruction after total gastrectomy. As of now, more than 70 reconstruction techniques following total gastrectomy have been reported, and each model has its own merits and demerits. Currently no ideal digestive reconstruction exists. The cores of these controversies are how to improve the postoperative quality of life on the basis of oncological and operative safety. The controversies focus on the following three aspects: (1) necessity of physiological duodenal passage; (2) necessity of a gastric pouch; (3) the optimal pouch configuration. Evidence-based medicine with large sample, multicentric, prospective randomized control trials is warranted.
Anastomosis, Surgical ; methods ; Gastrectomy ; methods ; Humans ; Stomach Neoplasms ; surgery

Gastrectomy ; methods ; Humans ; Laparoscopy ; methods ; Stomach Neoplasms ; epidemiology ; surgery