Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2022; 28(30): 4227-4230
Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4227
Benefits of minimally invasive surgery in the treatment of gastric cancer
Simone Sibio, Francesca La Rovere, Sara Di Carlo
Simone Sibio, Francesca La Rovere, Department of Surgery P. Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Umberto I University Hospital, Rome 00161, Italy
Sara Di Carlo, Minimally Invasive Surgery Unit, Department of Surgery, Tor Vergata University, Rome 00133, Italy
Author contributions: La Rovere F and Di Carlo S equally contributed in writing the draft; Di Carlo S revised the English language; Sibio S revised and approved the draft.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Simone Sibio, PhD, Associate Professor, Consultant Physician-Scientist, Lecturer, Surgical Oncologist, Department of Surgery P. Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Umberto I University Hospital, Viale del Policlinico 155, Rome 00161, Italy. simone.sibio@uniroma1.it
Received: November 17, 2021
Peer-review started: November 17, 2021
First decision: December 26, 2021
Revised: January 8, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 14, 2022

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 recurrence-free survival. The robotic approach to gastric cancer surgery aims to overcome the difficulties and technical limitations of laparoscopy in major surgery. The three-dimensional 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.

Keywords: Gastric cancer, Robotic gastrectomy, Laparoscopy, D2 lymphadenectomy, Long-term outcomes, Morbidity

Core Tip: Laparoscopic and robotic approaches are compared in the treatment of gastric cancer focusing on the prognostic factors as well as the oncological benefits brought about. While the long-term outcomes of laparoscopic surgery have been increasingly cited in recent years, only a few studies have analyzed the long-term results of the robotic approach, underlining the importance of future studies. A relevant aspect of robotic gastrectomy is the possibility to perform a more accurate lymph node dissection, which results in a longer survival with advanced gastric cancers.