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

摘要

In the largest study on laparoscopic gastrectomy, published in the November issue of Annals of Surgery, Kim et al report on 1237 patients with early gastric cancer who underwent a laparoscopy-assisted distal gastrectomy (LADG) with standardized D2 lymphadenec-tomy. The authors evaluated the safety of the procedure and particularly the role of comor-bidity in surgical outcomes. Overall, in-hospi-tal postoperative mortality was 0.6% and morbidity was 13%. This study raises 2 critical questions for Western evidence-based medicine. First, can LADG become a standard approach in the absence of randomized controlled trials? Second, in the age of personal genomics and global gene expression profiling, how may complete genome scans and predictive biomedicine influence adjuvant therapeutic decisions toward personalized treatment of gastric cancer? Will a local laparoscopic gastrectomy and a systemic patient-tailored adjuvant treatment guide the future management of gastric cancer? Indeed, laparoscopic surgical resection and selection of the best combination of empirical chemotherapy and targeted agents represent the primary goals for improving both quality of life and long-term survival.