The surgical treatment of gastric cancer in the era of minimally invasive surgery

Minimally invasive surgery is regarded as an alternative to conventional open surgery in gastric cancer. More and more surgeons devote their efforts to reduce surgical incision and acquire better recovery. Nowadays, laparoscopic distal gastrectomy has been the standard method for early stage cancer with remarkable advantage in short-term outcomes and is widely accepted by patients. The indication of laparoscopic gastrectomy has been extended to local advanced gastric cancer. However, the oncological safety has long been debated. Therefore, large scale randomized controlled clinical trials are ongoing to confirm the feasibility and safety in more advanced gastric cancer. With the accumulation of surgical experience and development of instrument, several advanced techniques, such as function preserving surgery, total laparoscopic anastomosis, sentinel node navigation surgery, robotic assisted surgery and reduced port laparoscopic gastrectomy have also been explored and applied to gastric cancer patient. All these techniques could modify the extent of surgery, reduce the risk of perioperative complications and generate potential better results in quality of life. Although recent studies have confirmed the feasibility and safety of each procedure, more evidence is required for further popularization of the newly technique. Herein we describe the current status and evidence for surgical treatment of gastric cancer in the era of minimally invasive surgery.