Abstract:
Gastric cancer surgery has entered an era that emphasizes on minimal invasiveness. Laparoscopic total gastrectomy for early gastric cancer employs high-level evidence-based medicine strategies. Laparoscopic distal gastrectomy for locally advanced gastric cancer has been retrospectively analyzed in a large number of cases, showing that robotic gastric cancer surgery can pick up more lymph nodes than laparoscopic surgery and has an advantage with respect to the incidence of surgical complications. Indocyanine green lymphatic navigation in gastric cancer can help surgeons identify more lymph nodes and is safe and reliable. The clinical value of splenic hilar lymph node dissection in locally advanced non-large-curvature gastric cancer warrants further investigation. Several phase Ⅱ clinical studies have shown encouraging short-term results with perioperative immunotherapy. The MATTERHORN study has also reported satisfactory short-term results. The short-term efficacy of the DRAGON Ⅳ study (with chemo-immuno-targeted therapy) has also met expectations. However, the KEYNOTE585 study did not meet the expectations. For perioperative immunotherapy, it is imperative to screen for immune-dominant populations.