Review 286 Laparoscopic surgery for gastric cancer: a systematic review 1 3 Summary Background Te objective of this paper is to systemati- cally review current literature on laparoscopic surgery for gastric cancer in terms of current indications and feasi- bility as well as short-term and long-term postoperative outcomes. Methods A systematic review was conducted with respect to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using PubMed and is up-to-date until January 1, 2014. Results A total of 99 papers matched the inclusion criteria and comprised of 92 case-control studies and 7 randomized controlled trials (RCTs). Te majority of these papers focused on short-term outcomes of lapa- roscopy-assisted distal gastrectomy (LADG), which are superior compared to open distal gastrectomy (ODG). Lymphadenectomy extent, morbidity, and mortal- ity rates as well as disease-free and overall survival did not difer signifcantly between LADG and ODG groups. Finally, the implementation of laparoscopic gastrectomy was assessed in advanced gastric carcinoma, obese, and elderly patients. Conclusions Tis systematic review revealed that lap- aroscopic surgery is safe and efective for the treatment of gastric cancer. LADG ofers better short-term and sim- ilar long-term results to ODG. Well-designed multicenter RCTs are needed to better understand the limitations of oncologic laparoscopic gastrectomy. Keywords Gastric cancer · Laparoscopy · Surgery · Lymph node excision Introduction Gastric cancer is the third most prevalent cancer and the second leading cause of malignancy-related mortality on a worldwide basis [1]. Novel endoscopic techniques have helped early detection of gastric cancer, especially in Asia where this malignancy is common [2]. Te pres- ence of lymph node metastases impacts the prognosis of early gastric cancer (EGC) and varies from 1.9 % in muco- sal carcinomas to 20.9 % in submucosal carcinomas [3]. EGCs with a low probability of lymph node involvement are usually treated with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) [4]. Nowadays, laparoscopic local resection techniques such as laparoscopic wedge resection (LWR) or intragastric mucosal resection (IGMR) are only rarely performed [5, 6]. In those EGCs where the risk of lymph node metas- tasis is high as well as in advanced gastric carcinomas (AGCs), endoscopic techniques cannot be utilized for curative intent. Radical gastrectomy with lymph node dissection is essential for the treatment of these types of cancer [7]. Initially, laparoscopy was implemented in order to determine the operability of gastric cancer [8]. Kitano K. S. Mylonas, MS () Medical School, Faculty of Health Sciences, Aristotle University of Tessaloniki, Kyriakidi Street 1, 54124 Tessaloniki, Greece e-mail: ksmylonas@gmail.com D. Schizas, MD · K. S. Mylonas, MS · K. P. Economopoulos, MD PhD · S. Tasigiorgos, MS · D. Patouras, MS Surgery Working Group, Society of Junior Doctors, Athens, Greece D. Schizas, MD · I. Karavokyros, MD PhD · T. Liakakos, MD PhD First Department of Surgery, University of Athens, Athens, Greece K. P. Economopoulos, MD PhD Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Received: 1 July 2015 / Accepted: 10 September 2015 / Published online: 25 September 2015 © Springer-Verlag Wien 2015 Eur Surg (2015) 47:286–302 DOI 10.1007/s10353-015-0350-8 Laparoscopic surgery for gastric cancer: a systematic review D. Schizas · K. S. Mylonas · K. P. Economopoulos · S. Tasigiorgos · D. Patouras · I. Karavokyros · T. Liakakos