Minimally Invasive Surgery in Gastric Cancer
Simple Summary
Abstract
1. Introduction
2. Evidence for Laparoscopic Gastrectomy
2.1. Laparoscopic Distal Gastrectomy for Early Gastric Cancer
2.2. Laparoscopic Distal Gastrectomy for Advanced Gastric Cancer
2.3. Laparoscopic Total Gastrectomy and Beyond
3. Beyond Standard Laparoscopy
3.1. Robotic Gastrectomy
3.2. Function-Preserving Surgery
3.3. Reduced-Port Surgery
4. MIS for Reducing Surgical Morbidity
5. Suggestions for Safe Initiation of MIS
6. Conclusions and Future Directions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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| Trial | Country | N | Stage | Primary Endpoint | Main Results |
|---|---|---|---|---|---|
| Early Gastric Cancer | |||||
| KLASS01 | Korea | 1416 | cStage I | 5Y OS | Comparable 5Y OS of LDG vs. ODG (94.2% vs. 93.3%, p = 0.64) Comparable cancer-specific survival of LDG vs. ODG (97.1% vs. 97.2%, p = 0.91) Lower overall complication rate in LDG (13.0% vs. 19.9%, p = 0.001) |
| JCOG0912 | Japan | 921 | cStage I | 5y RFS | Comparable 5Y RFS of LDG vs. ODG (94.0% vs. 95.1%, (HR, 0.84 [90% CI, 0.56–1.27]), p = 0.0075) Comparable in-hospital grade 3–4 surgical complications (3.3% in LDG vs. 3.7% in ODG, p = 0.72) |
| Advanced gastric cancer | |||||
| KLASS02 | Korea | 1050 | cT2-T4a cN0 or Limited perigastric LN | 3Y RFS | Comparable 3Y RFS of LDG to ODG (80.3% vs. 81.3%, p = 0.726) Comparable 5Y OS of LDG to ODG (88.9% vs. 88.7%, p = 0.30) Lower early complication rate of LDG (4.7% vs. 9.5%, p = 0.0038) Lower late complication rate of LDG (6.5% vs. 11.1%, p = 0.01) |
| JLSSG0901 | Japan | 502 | cT2-T4a cN0–2, excluding bulky LN | 5Y RFS | Comparable 5Y RFS of LDG to ODG (75.7% vs. 73.9%) Comparable 5Y OS of LDG to ODG (81.7% vs. 79.8%) Comparable overall postoperative complications (3.1% vs. 4.7%, p = 0.473) |
| CLASS01 | China | 1056 | cT1-T4a cN0-3, excluding bulky LN | 3Y DFS | Comparable 3Y DFS of LDG to ODG (76.5% vs. 77.8%) Comparable 3Y OS of LDG to ODG (83.1% vs. 85.2%) Comparable postoperative complication rate of LDG to ODG (15.2% vs. 12.9%, p = 0.845) |
| UMC- UPPERGI01 | Vietnam | 208 | cT4aN0-3, excluding bulky LN | 3Y DFS | Comparable overall postoperative complications (22.1% vs. 21.2%; p = 0.87) Comparable mortality rate (1.9% vs. 1.0%, p > 0.99) Ongoing follow-up for survival outcomes |
| Trial | Country | N | Stage | Primary Endpoint | Secondary Endpoints | Main Results |
|---|---|---|---|---|---|---|
| KLASS03 (Single-arm) | Korea | 170 | cStage I | Postoperative morbidity and mortality | Postoperative morbidity rate 20.6%, Major complication rate 9.4% Postoperative mortality rate 0.6% | |
| CLASS02 | China | 214 | cStage I | Postoperative morbidity and mortality | 5Y OS and DFS rates | Comparable 5Y OS of LTG to OTG (93.3% vs. 94.5%, p = 0.722) Comparable 5Y DFS of LTG to OTG (92.4% vs. 93.6%, p = 0.723) Comparable overall postoperative complication rate (18.1% vs. 17.4%) |
| STOMACH | Europe | 96 | cT1-4a, N0-3 periop chemotherapy | Quality of oncological resection | 3Y OS | Comparable 3Y OS of LTG to OTG (46.8% vs. 57.1%, p = 0.186) Comparable number of resected lymph nodes (40.7 vs. 44.3, p = 0.209) |
| LOGICA (Included both DG and TG) | Netherlands | 227 (TG = 91) | cT1-4aN0-3bM0 | Hospital stay days | postoperative complications and mortality, overall survival, quality of life, etc. | Comparable 1Y OS of LTG vs. OTG (76% vs. 78%, p = 0.74) Comparable postoperative complications, in-hospital mortality, hospital stay |
| Trial | Country | N | Procedure Types | Stages | Main Results |
|---|---|---|---|---|---|
| Ojima et al. | Japan | 241 | DG, TG, PG | Resectable GC (cStage I–III) | No difference in infectious complications Lower overall complication rates in Robotic group (8.8% vs. 19.7%, p = 0.02) Lower major complication rates in Robotic group (5.3% vs. 16.2%, p = 0.01) |
| Lu et al. | China | 283 | Only DG | Resectable GC (cStage I–III) | Lower overall complication rate in Robotic group (9.2% vs. 17.6%, 0.039) Higher 3-year disease-free survival in Robotic group (85.8% vs. 73.2%, p = 0.011) |
| Checklist | Key Elements |
|---|---|
| Stepwise patient selection | Begin with technically favorable cases, such as early-stage distal tumors Gradual expansion to more advanced disease, total gastrectomy, or neoadjuvant chemotherapy treated patients |
| Learning curve monitoring | Accumulate procedure-specific experience |
| Structured training and credentialing | Standardized education; mentorship; proctorship; video review; shared audit; external support or referral pathways for lower-volume centers |
| Quality monitoring | Textbook outcome measurements: R0 resection rate, lymph node yield, major complications, reoperation, ICU admission, 30-day mortality, length of stay, and readmission |
| Operative standardization | Standardized D2 lymphadenectomy; nodal station definitions; stepwise dissection; reconstruction protocol; clear conversion criteria; photo/video documentation |
| Institutional and multidisciplinary support | Centralization, dedicated operative teams, complication management system; referral pathway; multicenter audit network, tumor board |
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Kim, J.C.; Lee, H.-J. Minimally Invasive Surgery in Gastric Cancer. Cancers 2026, 18, 1876. https://doi.org/10.3390/cancers18121876
Kim JC, Lee H-J. Minimally Invasive Surgery in Gastric Cancer. Cancers. 2026; 18(12):1876. https://doi.org/10.3390/cancers18121876
Chicago/Turabian StyleKim, Jane Chungyoon, and Hyuk-Joon Lee. 2026. "Minimally Invasive Surgery in Gastric Cancer" Cancers 18, no. 12: 1876. https://doi.org/10.3390/cancers18121876
APA StyleKim, J. C., & Lee, H.-J. (2026). Minimally Invasive Surgery in Gastric Cancer. Cancers, 18(12), 1876. https://doi.org/10.3390/cancers18121876

