Robotic surgery for gastric cancer

Article information

J Korean Med Assoc. 2012;55(7):613-619
Publication date (electronic) : 2012 July 11
doi : https://doi.org/10.5124/jkma.2012.55.7.613
1Department of Surgery, Eulji University School of Medicine, Deajeon, Korea.
2Department of Surgery, Yonsei University College of Medicine, Korea.
Corresponding author: Woo Jin Hyung, wjhyung@yuhs.ac
Received 2012 June 13; Accepted 2012 June 27.

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.

References

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. 24568–72.
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. 161507–1513.
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. 251417–420.
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. 2230–234.
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. 53304–308.
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. 98515–519.
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. 23289–295.
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. 166e113–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. 7452–458.
10. Glantzounis G, Ziogas D, Baltogiannis G. Open versus laparoscopic versus robotic gastrectomy for cancer: need for comparative-effectiveness quality. Surg Endosc 2010. 241510–1512.
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. 249927–932.
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. 1461086–1092.
13. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011. 14101–112.
14. Noh SH, Hyung WJ, Cheong JH. Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol 2005. 90188–193.
15. Strong VE, Devaud N, Karpeh M. The role of laparoscopy for gastric surgery in the West. Gastric Cancer 2009. 12127–131.
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. 222753–2760.
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. 241232–237.
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. 22436–442.
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. 97169–172.
20. Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 2010. 24610–615.
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. 201841–845.
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. 161303–1310.
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. 231204–1211.
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. 117508–7511.
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. 3857–63.
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. 36331–337.
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. 211662–1666.
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. 20693–697.
29. Hyung WJ. Robotic surgery in gastrointestinal surgery. Korean J Gastroenterol 2007. 50256–259.
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. 261377–1381.

Article information Continued

Table 1

Advantages and disadvantages of robotic gastrectomy

Table 1

Lap, laparoscopic surgery; BMI, body mass index; LN, lymph node; LOS, length of stay; MIS, minimally invasive surgery; CTx, chemotherapy.