Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5694
Peer-review started: March 26, 2016
First decision: May 12, 2016
Revised: May 20, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: July 7, 2016
Processing time: 100 Days and 5.9 Hours
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.
Core tip: Laparoscopic gastrectomy has been demonstrated to be feasible and oncologically adequate for early gastric cancer (GC). Major criticism arose instead towards the spread of the use of laparoscopy for advanced GC, principally due to its poor suitability to complex maneuvers, such as extended lymphadenectomy. In recent years, robotic surgery techniques have been shown to make certain laparoscopic procedures easier and safer, such as during D2 lymph node dissection. Authors increasingly cite robotic-assisted gastrectomy as one of the most promising tools to extend the minimally invasive surgical indications for advanced GC patients.