In the last article, we covered therapeutic endoscopy as a method to treat stomach cancer in Japan. Today, we will be taking a look at laparoscopy, which is a type of minimally invasive surgery. Laparoscopic surgery was first used to treat stomach cancer in Japan in 1991.
As is the case with open abdominal surgery, patients undergoing laparoscopic surgery are given general anesthetic. First, carbon dioxide is passed into the abdominal cavity to expand it. Then, a laparoscope—a thin, state-of-the-art camera—is inserted through the belly button. At the same time, four or five tiny holes (each about 5 to 10 mm in width) are made in both sides of the abdomen. Surgical instruments are then passed through these holes to remove the affected portion of the stomach and nearby lymph nodes. At all times, the surgeon can see inside the stomach through images displayed on a monitor by the laparoscope.
The high-resolution magnified images captured by the laparoscope allow the surgeon to operate on areas (such as small blood vessels and nerves) that are difficult to view in clear detail during traditional open abdominal surgery. At the Cancer Institute Hospital of JFCR, laparoscopy is actively offered to treat stomach cancer in Japan, as it yields a high success rate and is a relatively gentle procedure that reduces the physical trauma experienced by the patient. The hospital is also conducting clinical research to better understand the level of safety and effects of the procedure.
Conditions treated with laparoscopy
At the Cancer Institute Hospital, laparoscopy is primarily offered to patients with early stomach cancer that cannot be entirely removed with endoscopy. Specifically, these are cases where the cancer has spread to the submucosa (the second innermost layer of the stomach), requiring the removal of nearby lymph nodes.
Most early stomach cancer is categorized as Stage I, which means there is a very good chance of the cancer being cured. For this reason, laparoscopy is offered as an alternative to open abdominal surgery, since it reduces the physical burden on the patient and allows them to recover more rapidly following the procedure.
Differences between laparoscopy and open abdominal surgery
Unlike open abdominal surgery, which requires making a 20-centimeter incision into the abdomen and directly handling the affected organ, laparoscopy involves inserting surgical instruments into the abdomen via 5 to 10 millimeter-wide openings and operating those instruments from outside the abdomen. The portion of the stomach removed and the extent of lymph node dissection is the same in both procedures, as it is dependent on the size, location, and stage of the cancer.
Laparoscopy also allows the patient’s digestive system to recover faster. This is because, due to the smaller incisions made in the abdomen, the patient experiences less pain. Another factor is the minimal impact that the procedure has on the other abdominal organs (such as the intestine). Patients who have had laparoscopic surgery can eat again relatively quickly, make a swift recovery, and return to their lives without much delay.
Pylorus-preserving gastrectomy: A gentler form of treatment
Following an operation on the stomach, a patient will not be able to eat as much as normal during one sitting, which may lead to malnourishment and food passing directly into the intestines without being properly digested. The latter is known as dumping syndrome, and can result in pain following a meal. One important aspect of stomach cancer treatment is to maintain as many of the patient’s gastric functions as possible so that the patient suffers less following surgery.
One way to accomplish this is to perform a pylorus-preserving gastrectomy. In this procedure, the stomach is cut in a way that preserves the pylorus, which is the part of the stomach that connects it to the small intestine. As long as the pylorus remains intact, the patient’s stomach can continue to function, thus preventing dumping syndrome. Removing the entire stomach drastically reduces the amount of food a person can intake. By preserving even one small portion of the stomach, a patient can avoid this problem.
Surgeons now take even further care to minimize incisions made in the patient during laparoscopy so that they suffer less pain following the procedure. In the past, even laparoscopy required making a 4- to 5-cm incision in the upper abdomen so the surgeon could connect the stomach and small intestine and remove affected tissue. Today, however, surgeons have many options available to them that require only slightly widening the hole in the belly button through which the laparoscope is inserted.