J Korean Med Assoc.  2012 Jul;55(7):613-619. 10.5124/jkma.2012.55.7.613.

Robotic surgery for gastric cancer

• Son T
• Hyung WJ

• KMID: 2192722
• DOI: http://doi.org/10.5124/jkma.2012.55.7.613

Abstract

Minimally invasive surgery (MIS) for gastric cancer has been gaining popularity. Although many surgeons have reported the feasibility of MIS for gastric cancer, difficulties in standard lymph node dissection and anastomoses during laparoscopic procedures have hindered the widespread use of this technique. To overcome these difficulties, a robotic system has been adopted and its feasibility and safety have been shown. However, robotic surgery for gastric cancer has shown few definite advantages over conventional laparoscopy so far. In addition, longer operation time and much higher cost for this procedure are consistently noted. Recently, some retrospective comparative studies have reported benefits of robotic surgery over laparoscopic gastrectomy such as more complete D2 lymph node dissection for advanced gastric cancer, less blood loss, and shorter learning curves. For the wider spread of robotic surgery for gastric cancer, well designed studies are required to verify patients' secondary advantages, the cost benefit trade-off, and oncologic outcomes.

Keyword

Gastrectomy; Robotic surgery; Minimally invasive surgery

MeSH Terms

Cost-Benefit Analysis
Gastrectomy
Laparoscopy
Learning Curve
Lymph Node Excision
Retrospective Studies
Stomach Neoplasms

Reference

1. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007. 245:68–72.

2. Strong VE, Devaud N, Allen PJ, Gonen M, Brennan MF, Coit D. Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case-control study. Ann Surg Oncol. 2009. 16:1507–1513.

3. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010. 251:417–420.

4. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999. 2:230–234.

5. Azagra JS, Ibanez-Aguirre JF, Goergen M, Ceuterick M, Bordas-Rivas JM, Almendral-Lopez ML, Moreno-Elola A, Takieddine M, Guerin E. Long-term results of laparoscopic extended surgery in advanced gastric cancer: a series of 101 patients. Hepatogastroenterology. 2006. 53:304–308.

6. Hur H, Jeon HM, Kim W. Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years' experience. J Surg Oncol. 2008. 98:515–519.

7. Tokunaga M, Hiki N, Fukunaga T, Miki A, Nunobe S, Ohyama S, Seto Y, Yamaguchi T. Quality control and educational value of laparoscopy-assisted gastrectomy in a high-volume center. Surg Endosc. 2009. 23:289–295.

8. D'Annibale A, Pende V, Pernazza G, Monsellato I, Mazzocchi P, Lucandri G, Morpurgo E, Contardo T, Sovernigo G. Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results. J Surg Res. 2011. 166:e113–e120.

9. Caruso S, Patriti A, Marrelli D, Ceccarelli G, Ceribelli C, Roviello F, Casciola L. Open vs robot-assisted laparoscopic gastric resection with D2 lymph node dissection for adenocarcinoma: a case-control study. Int J Med Robot. 2011. 7:452–458.

10. Glantzounis G, Ziogas D, Baltogiannis G. Open versus laparoscopic versus robotic gastrectomy for cancer: need for comparative-effectiveness quality. Surg Endosc. 2010. 24:1510–1512.

11. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009. 249:927–932.

12. Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, Noh SH. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg. 2011. 146:1086–1092.

13. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011. 14:101–112.

14. Noh SH, Hyung WJ, Cheong JH. Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol. 2005. 90:188–193.

15. Strong VE, Devaud N, Karpeh M. The role of laparoscopy for gastric surgery in the West. Gastric Cancer. 2009. 12:127–131.

16. Patriti A, Ceccarelli G, Bellochi R, Bartoli A, Spaziani A, Di Zitti L, Casciola L. Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma. Surg Endosc. 2008. 22:2753–2760.

17. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005. 241:232–237.

18. Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM. Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc. 2008. 22:436–442.

19. Hur H, Jeon HM, Kim W. Laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced (cT2) upper-third gastric cancer. J Surg Oncol. 2008. 97:169–172.

20. Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc. 2010. 24:610–615.

21. Lee HH, Hur H, Jung H, Jeon HM, Park CH, Song KY. Robot-assisted distal gastrectomy for gastric cancer: initial experience. Am J Surg. 2011. 201:841–845.

22. Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC, Li AF, Chiou SH, Wu CW. Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg. 2012. 16:1303–1310.

23. Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH. Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc. 2009. 23:1204–1211.

24. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol. 2005. 11:7508–7511.

25. Eom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY, Kim CG, Choi IJ, Lee JS, Kook MC, Rhee JY, Park SR, Kim YW. Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol. 2012. 38:57–63.

26. Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S. Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg. 2012. 36:331–337.

27. Anderson C, Ellenhorn J, Hellan M, Pigazzi A. Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc. 2007. 21:1662–1666.

28. Hur H, Kim JY, Cho YK, Han SU. Technical feasibility of robot-sewn anastomosis in robotic surgery for gastric cancer. J Laparoendosc Adv Surg Tech A. 2010. 20:693–697.

29. Hyung WJ. Robotic surgery in gastrointestinal surgery. Korean J Gastroenterol. 2007. 50:256–259.

30. Yoon HM, Kim YW, Lee JH, Ryu KW, Eom BW, Park JY, Choi IJ, Kim CG, Lee JY, Cho SJ, Rho JY. Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc. 2012. 26:1377–1381.