わが国における胃癌に対する低侵襲手術の現況

Abstract

Gastric cancer used to be the leading cause of cancer mortality in Japan, but the rate has been decreasing in recent years due to declining numbers of Helicobacter pylori infections. However, even now, it is still a major cancer in this country, ranking third in both the number of cases (2019) and number of deaths (2020). Treatment in the preoperative stages has improved thanks to the increased accuracy of preoperative examinations such as endoscopy and computed tomography, with treatment decisions based on prognosis in consideration of the stage of the disease, and the degree of invasiveness the patient will be able to tolerate. Endoscopic resection is indicated for mucosal cancer without lymph node metastasis (stage IA), while anticancer agents are used for stage IV patients with peritoneal dissemination and other cases where radical resection is impossible. Otherwise, surgery is the main treatment. In the past, open surgery dominated, but in recent years, minimally invasive laparoscopic surgery that creates smaller wounds has become widespread. Recently, robotic surgery with such functions as camera shake prevention has been developed, and this enables even more precise surgery. With reference to our own research, this article outlines the historical evolution of gastric cancer surgery and the current status of minimally invasive surgery.