Laparoscopic Gastrectomy and Personal Genomics: High-Volume Surgeons and Predictive Biomedicine May Govern the Future for Resectable Gastric Cancer

摘要

We appreciate the comments by Dr. DH Roukos and Dr. D Ziogas concerning our recently published report in Annals of Surgery. After laparoscopy-assisted distal gas-trectomy (LADG) was applied to treatment of early gastric cancer for the first time by a Japanese surgeon, it became a popular technique in Asian countries such as Korea and Japan. When applying new techniques like LADG to cancer surgery, we must consider several issues, including technical feasibility and oncologic availability. Contrary to your comment, there have been several randomized, controlled clinical trials in which surgical outcomes between laparoscopic and open gastrec-tomy for gastric cancer were compared, although the number of enrolled patients was small. One clinical trial proceeding in Italy reported the 5-year survival rates of 2 groups. Therefore, LADG is worth using for treatment of gastric cancer. In addition, multi-center prospective, randomized, controlled clinical trials (registered in www.clinicaltrials. gov as KLASS trial; NCT00452751) are currently underway to obtain confirmative results for LADG as a treatment method for gastric cancer by the authors of this article. However, laparoscopic surgery for gastric cancer should still be limited to early stages of the disease due to insufficient evidence of lymph node dissection, for the core of gastric cancer surgery, and the possibility of unexpected metastasis following the creation of a pneu-moperitoneum using CO_2 gas.