Surgical Approaches and Complications in Gastric Cancer Management

Surgical intervention remains the cornerstone of curative treatment for gastric carcinoma, encompassing a spectrum from conventional open gastrectomy to minimally invasive and robotic techniques. Open distal and total gastrectomy with systematic lymphadenectomy has long been adopted to achieve oncological clearance, while laparoscopic and robotic approaches are increasingly favoured for their reduced blood loss, lower rates of wound infection and shorter hospital stays. Technical refinements—such as precise infrared fluorescence imaging for lymphatic mapping and tailored nerve-preserving dissections—further enhance operative safety. Despite these advances, postoperative morbidity poses a persistent challenge. Anastomotic leakage, pancreatic fistula, intra-abdominal abscess and surgical-site infection contribute substantially to patient morbidity, prolonged convalescence and readmission rates. Risk factors range from patient-related variables such as malnutrition and comorbidity to procedure-related factors including prolonged operative time and lymphadenectomy extent. Early detection of complications, utilising biomarkers or drain-fluid assays, and standardised grading systems for adverse events are critical for optimal postoperative management. Globally, the shift towards minimally invasive and precision-guided surgery has practical implications for resource allocation, training and long-term functional outcomes.

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Surgical Approaches and Complications in Gastric Cancer Management publication trend

The graph below shows the total number of articles in surgical approaches and complications in gastric cancer management across all publications each year (not limited to Nature Index journals).

Technical terms

Gastrectomy: Surgical removal of part or all of the stomach to excise malignant tissue.

Laparoscopic gastrectomy: Minimally invasive stomach resection performed through small abdominal incisions with camera guidance.

Robotic gastrectomy: Robot-assisted resection offering three-dimensional vision and articulated instruments for precision dissection.

Anastomotic leak: Breakdown of the surgical connection between intestinal segments, leading to leakage of luminal contents.

Pancreatic fistula: Abnormal communication between pancreatic ductal structures and other tissues or body cavities following inadvertent pancreatic injury.

D2 lymphadenectomy: Extended lymph node dissection involving removal of perigastric and second-tier nodal stations for comprehensive nodal clearance.

References

1. Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: A retrospective cohort study based on a nationwide registry database in Japan. Annals of Gastroenterological Surgery (2017).
2. Neutrophil/Lymphocyte Ratio as Predictor of Anastomotic Leak after Gastric Cancer Surgery. Diagnostics (2020).
3. The measurement of amylase in drain fluid for the detection of pancreatic fistula after gastric cancer surgery: an interim analysis. World Journal of Surgical Oncology (2015).
4. Training system for laparoscopy-assisted distal gastrectomy. Surgery Today (2016).