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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2016; 22(25): 5694-5717
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5694
Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations
Stefano Caruso, Alberto Patriti, Franco Roviello, Lorenzo De Franco, Franco Franceschini, Andrea Coratti, Graziano Ceccarelli
Stefano Caruso, Franco Franceschini, Department of General Surgery and Surgical Specialties, Unit of General Surgery, “Santa Maria Annunziata” Hospital, ASL Firenze, 50012 Florence, Italy
Alberto Patriti, Department of Surgery, General Minimally Invasive and Robotic Surgery, "San Matteo degli Infermi" Hospital, 06049 Spoleto (PG), Italy
Franco Roviello, Lorenzo De Franco, Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery, University of Siena, 53100 Siena, Italy
Andrea Coratti, Division of Oncological and Robotic General Surgery, “Careggi” University Hospital, 50134 Florence, Italy
Graziano Ceccarelli, Department of Medicine and General Surgery, Unit of Minimally Invasive and General Surgery, ASL8 Arezzo, “San Donato” Hospital, 52100 Arezzo, Italy
Author contributions: Caruso S wrote and conceived the design of the study; De Franco L and Franceschini F contributed to the search for the literature and acquisition of data; Patriti A, Roviello F, Coratti A and Ceccarelli G contributed to the critical appraisal of the work, revising the article critically for important intellectual content and supervising the interpretation of data.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Stefano Caruso, MD, Department of General Surgery and Surgical Specialties, Unit of General Surgery, “Santa Maria Annunziata” Hospital, ASL Firenze, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy.
Telephone: +39-55-9508373 Fax: +39-349-8312397
Received: March 26, 2016
Peer-review started: March 26, 2016
First decision: May 12, 2016
Revised: May 20, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: July 7, 2016

Radical gastrectomy with an adequate lymphadenectomy 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 gastrectomy for 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 to evaluate the possible influence of robot gastrectomy on GC patient survival.

Keywords: Gastric cancer, Gastric resection, Minimally invasive surgery, Laparoscopic gastrectomy, Robot-assisted gastrectomy

Core tip: Laparoscopic gastrectomy has been demonstrated to be feasible and oncologically adequate for early gastric cancer (GC). Major criticism arose instead towards the spread of the use of laparoscopy for advanced GC, principally due to its poor suitability to complex maneuvers, such as extended lymphadenectomy. In recent years, robotic surgery techniques have been shown to make certain laparoscopic procedures easier and safer, such as during D2 lymph node dissection. Authors increasingly cite robotic-assisted gastrectomy as one of the most promising tools to extend the minimally invasive surgical indications for advanced GC patients.