Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer

Abstract

Background. Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical practice is still uncertain. We aimed to critically review the relevant evidence comparing robotic to standard laparoscopic surgery in performing radical gastrectomy. Methods. The Pubmed/Medline electronic databases were searched through February 2021. Paper conference and the English language was the only restriction applied to our search strategy. Results. According to the existing data, robotic gastrectomy seems to provide some benefits in terms of blood loss, rate of conversion, procedure-specific postoperative morbidity, and length of hospital stay. Robotic gastrectomy is also associated with a longer duration of surgery and a higher economic burden as compared to its laparoscopic counterpart. No significant differences have been disclosed in terms of long-term survivals, while the number of lymph nodes retrieved with robotic gastrectomy is generally higher than that of laparoscopy. Conclusions. The current literature suggests that robotic radical gastrectomy appears as competent as the conventional laparoscopic procedure and may provide some clinical advantages. However, due to the relative paucity of high-level evidence, it is not possible to draw definitive conclusions.

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

“…Unlike what happened up to 10 years ago, when it was struggling to spread out, robotic surgery has been turning into an integral part of clinical practice, due to different advantages of performing increasingly complex dissections and reconstructions in different surgical fields, when compared to traditional laparoscopic surgery [9,22,[35][36][37]. It is especially true in gastric surgery, whose minimally invasive reconstructions during total gastrectomy seem more challenging (esophagojejunal anastomosis, in particular), if compared to those performed during partial gastrectomies.…”

“…Nowadays, commercially available robotic equipment is marked by high costs, including acquisition costs, training expenses and costs of equipment-tool, in addition to maintaining costs for robotic system [41]. So high costs may justify the slowing spread of robotic assisted surgery [9,22,[35][36][37]41,42]. According to van Dam et al, in order to offset the initial costs for the acquisition of robotic devices, robotic surgery should be employed in more than 300 interventions per year, for 7 years, totalling up an amount of over 1000 euros per patient [43].…”

Benefits of minimally invasive surgery in the treatment of gastric cancer

“…Robotic gastrectomy is a safe and effective surgical technique when performed by experienced surgeons, however, it is associated with a longer operative time and a higher economic value than laparoscopic and open approaches[ 13 , 14 ]. Indeed, one of the factors that slows down the spread of robotic surgery is the particular technical expertise required while handling the robotic devices, resulting in a steeper learning curve for the specialized operator.…”