Basic concept of gastric cancer treatment when we consider the social backgroud of the aging society is undoubtedly ’’ minimally invasive and tailored approaches”.

 

Since Theodor Billroath performed the first gastrectomy in 1881， a number of improvements and developments have been made in the surgical management of gastric cancer. Today， we are utilizing not only surgical procedure but also multidisciplinary approaches. In the 20th century， we saw the establishment of standard procedures of resection， lymph node dissection and reconstruction in gastric cancer surgery. Now， in 21st century， I believe the key word for further improving the management GI cancer　is ’’ individualization’’. Because of well-established health check-up system and widespread application of video-endoscopy in Japan， many asymptomatic cases of early gastric cancer (EGC) are detected. Endoscopic submucosal dissection (ESD) is already accepted as most minimally invasive procedure for the resection of EGC. We have examined a method using an oblique view double channel therapeutic video-endoscope for larger mucosal cancer (ESD). Laparoscopic surgery is an important intermediate option between ESD and open surgery for patients with EGC. Now， we have many skilled laparoscopic surgeons demonstrating the technical feasibility of a complete laparoscopic gastrectomy or D2 lymphoadenectomy even in advanced gastric cancer. Currently the diagnostic sensitivity of preoperative imagings to detect micrometastasis in regional lymph nodes has developed to perform precisely the minimally invasive and tailored approaches for gastric cancer ( Concept of Sentinel Node Navigation Surgery). Fluorescence image guided surgery is a candidate for supporting intraoperative recognition of lymphatic flow， lymphatic metastasis and organ blood flow.

 

Laparoscopic surgery is a relatively difficult procedure for surgeons because of the limitations of maneuverability and tactile sensation. To prove these problems， we need to develop the harmonization between medicine and technology.

 

Advanced engineering technology， especially robotics， has already been in laparoscopic surgery. We have developed a combined master-slave manupulator with tactile sensation. On the other hand， future advanced medical devices are promoting supported by Japan Agency for Medical Research and Development as national policy.

 

Finally the important concept of treatment for gastric cancer is multidisciplinary approach including chemotherapy and herbal medicine ( Kampo ).