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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2017; 9(1): 1-11
Published online Jan 16, 2017. doi: 10.4253/wjge.v9.i1.1
Robot-assisted laparoscopic gastrectomy for gastric cancer
Stefano Caruso, Franco Franceschini, Alberto Patriti, Franco Roviello, Mario Annecchiarico, Graziano Ceccarelli, Andrea Coratti
Stefano Caruso, Franco Franceschini, Department of General Surgery and Surgical Specialties, Unit of General Surgery, “Santa Maria Annunziata” Hospital, 50012 Florence, Italy
Alberto Patriti, Department of Surgery, General Minimally Invasive and Robotic Surgery, “San Matteo degli Infermi” Hospital, 06049 Spoleto, Italy
Franco Roviello, Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, 53100 Siena, Italy
Mario Annecchiarico, Andrea Coratti, Division of Oncological and Robotic General Surgery, “Careggi” University Hospital, 50134 Florence, Italy
Graziano Ceccarelli, Department of Medicine and General Surgery, Unit of Minimally Invasive and General Surgery, “San Donato” Hospital, 52100 Arezzo, Italy
Author contributions: Caruso S wrote and conceived the study; Franceschini F and Annecchiarico M contributed to the literature search and acquisition of data; Patriti A, Roviello F, Ceccarelli G and Coratti A contributed to the critical appraisal of the work, revising the article critically for important intellectual content.
Conflict-of-interest statement: All authors disclose any potential or actual personal, political or financial conflict of interest in the material, information or techniques described in the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stefano Caruso, MD, Department of General Surgery and Surgical Specialties, Unit of General Surgery, “Santa Maria Annunziata” Hospital, ASL Firenze, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy. stefano.caruso@teletu.it
Telephone: +39-55-9508373
Received: June 22, 2016
Peer-review started: June 27, 2016
First decision: August 11, 2016
Revised: September 15, 2016
Accepted: October 25, 2016
Article in press: October 27, 2016
Published online: January 16, 2017
Processing time: 195 Days and 9.5 Hours
Abstract

Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer.

Keywords: Gastric cancer, Gastric resection, Minimally invasive surgery, Robot-assisted gastrectomy

Core tip: Laparoscopic gastrectomy has been shown to be a viable option for early gastric cancer, showing survival rates comparable to those of open procedure. However, there has been criticism concerning the routine use of laparoscopy in patients with advanced gastric cancer, principally because it adapts poorly to complex maneuvers like D2 lymphadenectomy. Robotic surgery has been shown to make certain laparoscopic procedures easier and safer. Reports have recently shown the ever increasing feasibility and safety of robotic assisted laparoscopic gastrectomy for gastric cancer, in some cases even proving superior to traditional laparoscopy.