Robotic gastrectomy for gastric cancer

Robotic gastrectomy(RG)is increasingly performed,particularly in East Asia.With articulated devices,surgeons are able to perform every procedure more comfortably and meticulously,which makes RG ideal from the surgeon’s standpoint.However,it is still unclear whether it is a suitable treatment strategy from the patient’s viewpoint,due to the lack of solid evidence obtained from randomized controlled trials.The feasibility of RG has been demonstrated in many retrospective comparative studies,which showed similar trends,including relatively less estimated blood loss and longer operation time with RG than laparoscopic gastrectomy(LG),equivalent number of harvested lymph nodes and similar length of postoperative hospital stay between RG and LG.However,considering the higher medical expenses associated with RG,its superiority in terms of long-term survival outcomes will need to be confirmed for it to be accepted more widely.

Current role of minimally invasive approaches in the treatment of early gastric cancer

Despite declining incidence,gastric cancer remains one of the most common cancers worldwide.Early detection in population-based screening programs has increased the number of cases of early gastric cancer,representing approximately 50%of newly detected gastric cancer cases in Asian countries.Endoscopic mucosal resection and endoscopic submucosal dissection have become the preferred therapeutic techniques in Japan and Korea for the treatment of early gastric cancer patients with a very low risk of lymph node metastasis.Laparoscopic and robotic resections for early gastric cancer,including function-preserving resections,have propagated through advances in technology and surgeon experience.The aim of this paper is to discuss the recent advances in minimally invasive approaches in the treatment of early gastric cancer.

Laparoscopic gastric surgery for cancer: Where do we stand?

Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.

Robotic total gastrectomy for carcinoma in the remnant stomach:a comparison with laparoscopic total gastrectomy

Background Total gastrectomy for carcinoma in the remnant stomach(CRS)remains a technically demanding procedure.Whether robotic surgery is superior,equal,or inferior to laparoscopic surgery in patients with CRS is unclear.This study was designed to compare the efficacy and safety of robotic total gastrectomy(RTG)and laparoscopic total gastrectomy(LTG)for the treatment of CRS.Methods In this cohort study,we retrospectively analysed the data from patients who underwent RTG or LTG for CRS at Southwest Hospital(Chongqing,China)between May 2006 and October 2019.The surgical outcomes,post-operative complications,and survival outcomes between the two groups were compared.Results Compared with LTG,RTG was associated with similar effective operation time(272.0 vs 297.9 min,P=0.170),higher total costs(105,967.2 vs 81,629.5 RMB,P<0.001),and less estimated blood loss(229.2 vs 288.8 mL,P=0.031).No significant differences were found between the robotic and laparoscopic groups in terms of conversion rate,time to first flatus,time to first soft diet,post-operative hospital stay,post-operative complications,R0 resection rate,and number of retrieved lymph nodes(all P>0.05).The 3-year disease-free survival and 3-year overall survival rates were comparable between the two groups(65.5%vs 57.5%,P=0.918;69.0%vs 60.0%,P=0.850,respectively).Conclusions RTG is a safe and feasible procedure for the treatment of CRS and could serve as an optimal treatment for CRS.

Benefits of minimally invasive surgery in the treatment of gastric cancer

We read with great interest the article that retrospectively analyzed 814 patients with primary gastric cancer,who underwent minimally invasive R0 gastrectomy between 2009 and 2014 by grouping them in laparoscopic vs robotic procedures.The results of the study highlighted that age,American Society of Anesthesiologists status,gastrectomy type and pathological T and N status were the main prognostic factors of minimally invasive gastrectomy and showed how the robotic approach may improve long-term outcomes of advanced gastric cancer.According to most of the current literature,robotic surgery is associated with a statistically longer operating time when compared to open and laparoscopic surgery;however,looking at the adequacy of resection,defined by negative surgical margins and number of lymph nodes removed,it seems that robotic surgery gives better results in terms of the 5-year overall survival and recurrencefree survival.The robotic approach to gastric cancer surgery aims to overcome the difficulties and technical limitations of laparoscopy in major surgery.The threedimensional vision,articulation of the instruments and good ergonomics for the surgeon allow for accurate and precise movements which facilitate the complex steps of surgery such as lymph node dissection,esophagus-jejunal anastomosis packaging and reproducing the technical accuracy of open surgery.If the literature,as well as the analyzed study,offers us countless data regarding the short-term oncological results of robotic surgery in the treatment of gastric cancer,satisfactory data on long-term follow-up are lacking,so future studies are necessary.