Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits

Parisi, Amilcare; Nguyen, Ninh T.; Reim, Daniel; Zhang, Shu; Jiang, Zhiwei; Brower, Steven T.; Azagra, J. S.; Facy, Olivier; Ali̇moğlu, Orhan; Jackson, Patrick G.; Tsujimoto, Hironori; Kurokawa, Yukinori; Zang, Lu; Coburn, Natalie; Yu, Peiwu; Zhang, Ben; Qi, Feng; Coratti, Andrea; Annecchiarico, Mario; Novotny, Alexander; Goergen, Martine; Lequeu, Jean-Baptiste; Eren, Tunç; Leblebici, Metin; Al‐Refaie, Waddah B.; Takiguchi, Shuji; Ma, Junjun; Zhao, Yongliang; Liu, Tong; Desiderio, Jacopo

doi:10.1016/j.ijsu.2015.02.021

Cited by 28 publications

(25 citation statements)

References 46 publications

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“…Although patient selection has an important role in the feasibility of achieving an adequate oncologic resection and lymph node retrieval, a surgical approach was likewise found to be an important factor in the likelihood of resecting at least 15 nodes. Proponents of robotic technology, in particular, cite greater technical precision, more degrees of freedom in instrument articulation, and better visualization of anatomy relative to other surgical approaches [10]. With most of the experience and literature regarding surgery for gastric cancer coming from the East, previously published studies show a greater quantity of lymph nodes harvested during minimally invasive surgery, yet there is a general lack of consensus regarding improved R0 resection rates on the basis of the approach alone [11,[19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive surgery for gastric cancer: the American experience

et al. 2016

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Background Minimally invasive surgical techniques are increasingly being implemented in oncologic care. This study assesses the impact of minimally invasive surgery on oncologic and perioperative outcomes in the management of gastric cancer in the USA. Methods From the American College of Surgeons and American Cancer Society National Cancer Data Base, we identified 6427 patients who underwent gastrectomy for cancer from 2010 to 2012. Treatment groups were categorized with an intention-to-treat paradigm as robotic, laparoscopic, and open surgery. Univariate and multivariate analyses were performed to estimate the impact of the surgical approach on oncologic and perioperative outcomes. Results Of patients undergoing definitive surgical intervention, 3.5 % (n = 223) underwent robotic gastrectomy, 23.1 % (n = 1487) underwent laparoscopic gastrectomy, and 73.4 % (n = 4717) underwent open surgery. Minimally invasive gastrectomy was more frequently performed on white (P = 0.018), privately insured patients (P = 0.049) treated at academic centers (P \ 0.0001) in the eastern USA (P \ 0.0001). After demographics, comorbidities, and tumor-related factors had been controlled for, patients who underwent laparoscopic gastrectomy had the postoperative length of stay decreased by 1.08 days (P \ 0.0001) and greater odds of having at least 15 lymph nodes resected (odds ratio 1.16, P = 0.023). Use of robotic surgery did not have a statistically significant effect on the postoperative length of stay relative to open surgery (P = 0.222) but the patients so treated had greater odds of having at least 15 lymph nodes resected (odds ratio 1.51, P = 0.005). There were no differences in R0 resection rates or perioperative mortality on the basis of the surgical approach alone. Conclusions These findings suggest that use of minimally invasive surgery for gastric cancer in the USA is impacting the adequacy of oncologic resection but is not yet having a clinically significant impact on perioperative outcomes relative to a conventional open approach.

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Section: Discussionmentioning

confidence: 99%

“…The benefits of minimally invasive surgical methods are proven and well published [6,[10][11][12][13][14][15][16]. With advantages such as decreased postoperative pain and shorter length of hospital stay, minimally invasive techniques are heralded as a significant development in the progress of general surgery.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgery for gastric cancer: the American experience

et al. 2016

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“…Gastric surgery is one of the most relevant and developed fields of minimally invasive surgery[2]. Although general international support has emerged in its application at dedicated centers, practitioners must still assess which patients would benefit most from these technologies.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

Parisi¹,

Reim²,

Borghi³

et al. 2017

WJG

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AIMTo investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODSThis is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTSThe present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups.CONCLUSIONLaparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

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“…Researchers are currently debating several points, 32 first, the need to perform an adequate lymphadenectomy with minimally invasive techniques. With laparoscopy, surgeons can feasibly remove at least 15 lymph nodes, 26 but research has shown a statistically significant difference in favor of the open approach regarding the total number of retrieved lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis

et al. 2015

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Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis.Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run.A new reconstructive approach, not yet described in literature, was recently adopted at our Center.Robotic total gastrectomy with D2 lymphadenectomy and a so-called “double-loop” reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases.Preoperative, intraoperative, and postoperative data were collected and a technical note was documented.All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred.Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery.The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.

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Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits

Abstract: A multicenter study with a large number of patients is now needed to further investigate the safety and efficacy as well as long-term outcomes of robotic surgery, traditional laparoscopy and the open approach.

Cited by 28 publications

References 46 publications

Minimally invasive surgery for gastric cancer: the American experience

Minimally invasive surgery for gastric cancer: the American experience

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis

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