April 14, 2018
Travis E. Grotz, M.D., a surgical oncologist at Mayo Clinic in Rochester, Minnesota, answers questions about Mayo's increasing use of this minimally invasive approach.
Why is Mayo Clinic offering laparoscopic surgery to more patients with gastric cancer?
Recent randomized trials have shown that the minimally invasive approach is safe not just for early gastric cancer but also for more advanced disease.
We had been using the minimally invasive approach primarily for early cancers because of concerns about adequate resection in advanced cases. But recent randomized trials have shown that laparoscopic gastrectomy is safe not just for early gastric cancer but for more advanced disease. We now feel comfortable recommending laparoscopic gastrectomy for more advanced gastric cancer, which is what we predominantly see at Mayo Clinic.
What advantages does laparoscopic gastrectomy offer for patients?
The operating time is longer — five or six hours versus about three hours for open surgery — but the recovery is faster. Patients generally have less blood loss and pain and are able to eat and return to normal bowel function more quickly. The hospital stay is shorter — three or four days compared with five to seven days for open surgery — and the patient is less likely to need a feeding tube after laparoscopic gastrectomy.
Another potential benefit involves perioperative chemotherapy. Only about half the patients with gastric cancer are able to tolerate chemotherapy after open surgery. We don't yet have evidence to bear this out, but the faster recovery from laparoscopic gastrectomy might help more patients through perioperative chemotherapy.
Are certain patients less suitable for laparoscopic gastrectomy?
Patients with T4 tumors involving the pancreas and colon are probably best treated with open surgery because the potential for complications is dramatically increased. The laparoscopic procedure also might not provide adequate visualization in patients who are very obese or patients with adhesions from previous abdominal surgeries.
How does Mayo Clinic's multidisciplinary approach benefit patients with gastric cancer?
Our multidisciplinary care for patients with gastric cancer starts with the complex evaluation and staging of the tumor, including endoscopic ultrasound by our gastroenterologists, CT and PET scans by our GI radiologist, and a diagnostic laparoscopy and peritoneal cytology by our surgical oncologist and GI pathologist. Our medical oncologist works with the patient's local medical oncologist to deliver neoadjuvant systemic chemotherapy, and we selectively use perioperative radiation by our radiation oncologist if margins or bulky lymphadenopathy is a concern.
Finally, the surgical oncologist and nutritionist work closely to educate and facilitate postoperative recovery. The multidisciplinary care continues in surveillance as we collaborate not only to follow for recurrence but also to monitor nutrition and quality of life concerns after gastrectomy.
Gastric cancer is a model for multidisciplinary care at Mayo Clinic, and an important reason why we're able to offer patients advanced procedures, such as laparoscopic gastrectomy.