《Table 2 Updated preoperative indications for endoscopic submucosal dissection in Japanese gastric c

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《Precision surgical approach with lymph-node dissection in early gastric cancer》

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Kinami et al[51]evaluated the superiority in PGS and QOL at least 1 year after surgery of patients who underwent laparoscopic gastrectomy，using data from the PGSAS study for additional analysis.The outcome measures included in the PGSAS-45 are classified into three domains:the symptom domain，the living status domain，and the QOL domain[34].A few main outcome measures of PGSAS-45 were superior after laparoscopic，compared to conventional open，DG surgery.These measures were:The need of additional food；dissatisfaction with symptoms；and the mental component summary of SF-8.These items were of the living status or QOL domain，not the symptom domain.In contrast，for TG，there was no difference in the scores of main outcome measures between laparoscopic surgery and conventional open surgery.From this large-scale analysis，it was concluded that there is no advantage for laparoscopic TG from the viewpoint of the PGS[51].Generally，the only difference between laparoscopic surgery and conventional open surgery is the length of the incision.Therefore，a large difference in PGS between laparoscopic and open surgery would not be expected.