Minimally Invasive Surgery in Gastric Cancer

Minimally invasive gastrectomy has become an established surgical approach for gastric cancer, supported by randomized trials demonstrating oncologic outcomes comparable to open surgery. Initially applied mainly to early-stage disease, laparoscopic gastrectomy has gradually expanded to selected patients with advanced gastric cancer and to more complex procedures, including total gastrectomy. In parallel, robotic surgery and reduced-port techniques have further broadened the technical spectrum of minimally invasive gastric cancer surgery. This review summarizes current evidence on laparoscopic, robotic, and reduced-port gastrectomy, with emphasis on randomized trials, large-scale clinical studies, and recent guideline recommendations. Laparoscopic distal gastrectomy has shown robust oncologic equivalence in early and selected advanced gastric cancer, while evidence for laparoscopic total gastrectomy continues to grow, particularly in experienced centers. Robotic and reduced-port approaches appear feasible and safe in selected settings, although clear superiority over standard laparoscopy has not been established. As minimally invasive techniques are adopted more widely, careful consideration is needed during program development and expansion. Patient selection, surgeon experience, learning curve, institutional volume, standardized operative procedures, quality control, and multidisciplinary support are important factors for safe implementation. Future studies should focus not only on comparing surgical approaches, but also on defining how minimally invasive gastrectomy can be applied safely and consistently across diverse clinical settings.