Total Gastrectomy and Roux-En-Y Reconstruction
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Introduction
Gastric cancer is one of the most common organ malignancies worldwide and surgical resection, predominantly as part of multimodal strategy, is an essential element to treating this cancer. Currently, gastrectomy with Roux-en-Y reconstruction is the procedure of choice for treating proximal gastric cancer, and the tumors of the gastro-esophageal junctions (GEJ) that are classified as Siewert III. This being said, mortality and morbidity risks for this procedure still remain high, while this surgery also requires being performed in high-volume centers. What is more, for many years, the open approach with radical lymphadenectomy was the standard approach to treatment. However, in the past few decades minimally invasive techniques have become more common, this is because of their advantages, which include: shorter hospital stay, less postoperative pain and a quicker recovery. Additionally, this procedure can be done completely under laparoscopy and even more recently it has been proposed to be done through robot-assistance. The technical disadvantages of laparoscopy have been greatly reduced by robot-assisted surgery with its seven degrees of freedom, 3D vision, tremor filtering and improved ergonomics. In the remaining part of this chapter, we will describe both of these approaches in greater detail and how minimally invasive surgery techniques (e.g., laparoscopy and robot-assisted surgery) are making great strides in treating gastric cancer.
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Introduction
Gastric cancer is one of the most common organ malignancies worldwide and surgical resection, predominantly as part of multimodal strategy, is an essential element to treating this cancer. Currently, gastrectomy with Roux-en-Y reconstruction is the procedure of choice for treating proximal gastric cancer, and the tumors of the gastro-esophageal junctions (GEJ) that are classified as Siewert III. This being said, mortality and morbidity risks for this procedure still remain high, while this surgery also requires being performed in high-volume centers. What is more, for many years, the open approach with radical lymphadenectomy was the standard approach to treatment. However, in the past few decades minimally invasive techniques have become more common, this is because of their advantages, which include: shorter hospital stay, less postoperative pain and a quicker recovery. Additionally, this procedure can be done completely under laparoscopy and even more recently it has been proposed to be done through robot-assistance. The technical disadvantages of laparoscopy have been greatly reduced by robot-assisted surgery with its seven degrees of freedom, 3D vision, tremor filtering and improved ergonomics. In the remaining part of this chapter, we will describe both of these approaches in greater detail and how minimally invasive surgery techniques (e.g., laparoscopy and robot-assisted surgery) are making great strides in treating gastric cancer.
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