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Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

World Journal of Gastroenterology 2016年第25期22卷 5694-5717页

作者： Stefano Caruso Alberto Patriti Franco Roviello Lorenzo De Franco Franco Franceschini Andrea Coratti Graziano Ceccarelli Department of General Surgery and Surgical Specialties Unit of General Surgery 'Santa Maria Annunziata' Hospital ASL Firenze 50012 Florence Italy Department of Surgery General Minimally Invasive and Robotic Surgery 'San Matteo degli Infermi' Hospital 06049 Spoleto (PG) Italy Department of Medical Surgical and Neuroscience/ Unit of General and Minimally Invasive Surgery University of Siena 53100 Siena Italy Division of Oncological and Robotic General Surgery 'Careggi' University Hospital 50134 Florence Italy Department of Medicine and General Surgery Unit of Minimally Invasive and General Surgery ASL8 Arezzo 'San Donato' Hospital 52100 Arezzo Italy

Radical gastrectomy with an adequate lymph-adenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer(GC). A number of randomized controlled trials and meta-analysis provide phase Ⅲ evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomyfor cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed

关键词： Gastric cancer Gastric resection Minimally invasive surgery Laparoscopic gastrectomy robotassisted g

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