Summary: Minimally invasive abdominal surgery became more advanced and widely applied during the last decades by technical development of modern equipment and increased laparoscopic skills and adequate training of the surgeons. Furthermore, formerly considered absolute contraindications of this procedure have changed to be only relative contraindications in benign as well as in malignant surgical diseases. This fact is also true for gastric surgery and the majority of operations in metabolic surgery, benign- or gastrointestinal stromal tumors resp. and perforation of peptic ulcer is performed with a laparoscopic approach. Surgery of gastric cancer must observe oncological principles as adequate lymphadenectomy and tumor-free resection margins. These requirements must be fulfilled also in minimally invasive surgery to be equivalent to an open procedure. Kitano reported the first distal gastrectomy with a laparoscopic approach for an early gastric cancer in 1994. After that several studies started for the treatment of stage I cancer in Asia and this procedure was recommended according to the Japanese guidelines. In the meantime the German guidelines recommended also this kind of treatment but only for early gastric carcinomas founded on the oncological outcome data. For more advanced cancer, there is currently no evidence to recommend a laparoscopic approach although similar results can be expected as those after minimally invasive surgery for early gastric cancer. Some studies are on the way but a final decision must be awaited because a Cochrane-analysis of a total of 2528 randomized patients undergoing laparoscopic or open gastrectomy resp. stated that the data are sparse with wide confidence intervals and significant benefits or harms of laparoscopic gastrectomy cannot be ruled out. Furthermore, evidence for minimally invasive surgery mainly based on Asian studies from Japan and Korea. Several differences exist between populations compared to Europe with patients having a higher BMI, much more advanced tumor stages, higher incidence of tumors in the upper third of the stomach or gastroesophageal junction and less high volume centers. The latter aspect might be the most important factor resulting in limited skills and experiences of the surgeon in complex oncological operations. Therefore, minimally invasive gastric surgery cannot be recommended in general above all not in advanced gastric tumor stages at the moment.
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