Abstract
A robotic approach to abdominal surgery procedures may improve postoperative outcomes compared to either open or laparoscopic approaches. The role of robotics for gastric surgery, however, is still being evaluated. A retrospective review of the prospectively maintained database for robotic gastric surgery at University of Siena between 2011 and 2020 was conducted. Data regarding surgical procedures, early postoperative outcomes, and long-term follow-up were analyzed. 38 patients underwent robotic partial or total gastrectomy. Conversion to open occurred in two patients (5.2%) due to locally advanced disease as well as difficult identification of primary lesion. Postoperative morbidity was 13.1% while no postoperative mortality was registered. The mean length of operation was 358.6 (220–650) minutes and the mean number of retrieved lymph nodes was 35.8 (range: 5–73). The median OS of all population was 70.9 months. The median 5-year OS for the patients with positive nodes was worse than that of patients without metastatic lymph nodes [51.4 months (95% CI 35.5–67.4) vs. 79.5 months (95% CI 67.1–91.8); p = 0.079]. The interesting results including postoperative morbidity as well as mortality rate, the surgical outcomes, and the 5-year OS, were to be acceptable considering the data recorded by previous studies on robotic gastrectomy. This study demonstrated that robotic gastrectomy is feasible and can be safely performed. However, further follow-up and randomized clinical trials are required to confirm the role of a robotic approach in gastric cancer surgery.
Highlights
During the last decades, several studies have provided evidence that laparoscopic surgery for gastric cancer is technically safe and that it leads to better short-term outcomes than conventional open gastrectomy for early-stage gastric cancer
We investigated the differences in overall survival (OS) between patients with and without lymph node metastasis
Our Western single center activity shows encouraging results, since on a total of 38 enrolled patients treated with robotic approach, no postoperative mortality was registered while complications occurred in 13.2% of patients
Summary
Several studies have provided evidence that laparoscopic surgery for gastric cancer is technically safe and that it leads to better short-term outcomes than conventional open gastrectomy for early-stage gastric cancer. A safer D2 spleen-preserving laparoscopic gastrectomy for the treatment of advanced gastric cancer did not meet the same success and is currently available only in high-volume centers. Technical difficulties due to total gastrectomy procedure as well as D2 lymphadenectomy, entailing the removal of node stations along the celiac trunk, left gastric artery and hepatic pedicle, are advocated as limiting factor of laparoscopic surgery diffusion. To overcome some intrinsic limitations of the traditional laparoscopic approach,. Updates in Surgery (2021) 73:865–872 outcomes of a consecutive series of full robotic gastrectomies using the Da Vinci Surgical System
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