Minimally invasive surgery for gastric cancer

Improvements in the curative treatment of gastric cancer notwithstanding, surgical and oncological outcomes of patients remain poor. Gastrectomy is a major surgical procedure with relatively high morbidity and mortality, and 5-year overall survival rates are below 40%. This thesis evaluated several aspects of minimally invasive gastrectomy, surgical techniques, and perioperative management, in order to optimize the curative treatment of gastric cancer. Optimization of treatment will ultimately improve the outcomes of patients with gastric cancer. It was demonstrated that minimally invasive gastrectomy has been safely introduced in the Netherlands and is being performed with increasing frequency. Moreover, the outcomes of minimally invasive gastrectomy compare favorably to those of open gastrectomy: they include shorter hospital stay, less wound complications, and improved quality of life. In contrast to using a minimally invasive approach, the extent of resection during the procedure should be thorough – including an extended lymphadenectomy and omentectomy – in order to provide an optimal oncological result. Last, it was found that the timing of treatment does not influence oncological outcomes, and that timing of treatment should therefore be based on other factors, such as patient condition. New trials designed as part of this thesis are ongoing and they are expected to further improve outcomes for patients with gastric cancer