Gastric cancer surgery advances from open operations to AI
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Surgeons in East Asia transformed gastric cancer surgery over the last three decades, moving from traditional open operations to minimally invasive techniques and now exploring artificial intelligence.
In the 1990s, surgeons such as Kajitani, Okajima, and Maruyama established the importance of systematically removing lymph nodes around the stomach, a practice called D2 lymphadenectomy, to improve cancer treatment.
Later, Sasako’s research showed that adding extra lymph node removal didn't improve survival, leading to a focus on balancing effective surgery with patient quality of life. In 1994, Kitano performed the first laparoscopic gastrectomy, a keyhole surgery for gastric cancer. Despite initial skepticism, surgeons in Japan, Korea, and China systematically evaluated and refined the technique through trials.
Studies like KLASS-01 and JCOG0912 demonstrated that laparoscopic surgery was as effective as open surgery for early and locally advanced gastric cancer, with fewer complications. Robotic surgery also emerged, but requires further research to confirm its benefits. Currently, surgeons are focused on optimizing procedures and personalizing treatment. Techniques like SPADE and OFFROAD aim to improve reconstruction after surgery and reduce complications.
They are also exploring ways to preserve more of the stomach when possible and improving patient health before operations by addressing anemia and managing blood effectively. Artificial intelligence is now being used to detect early cancer, guide surgeons during procedures, and predict patient outcomes, though challenges around data privacy and reliability remain.
