Marrelli D, Carbone L, Poto GE, Fusario D, Gjoka M, Andreucci E, Piccioni SA, Calomino N, Sandini M, Roviello F. Minimally invasive lymphadenectomy for gastric cancer: Could the robotic approach provide any benefits than laparoscopy? World J Gastrointest Oncol 2025; 17(6): 104015 [DOI: 10.4251/wjgo.v17.i6.104015]
Corresponding Author of This Article
Daniele Marrelli, MD, Professor, Department of Medicine Surgery and Neuroscience, University of Siena, Via Banchi di Sotto 55, Siena 53100, Tuscany, Italy. daniele.marrelli@ao-siena.toscana.it
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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: http://creativecommons.org/licenses/by-nc/4.0/
Daniele Marrelli, Ludovico Carbone, Gianmario Edoardo Poto, Daniele Fusario, Mattheus Gjoka, Eleonora Andreucci, Stefania Angela Piccioni, Marta Sandini, Franco Roviello, Department of Medicine Surgery and Neuroscience, University of Siena, Siena 53100, Tuscany, Italy
Daniele Marrelli, Stefania Angela Piccioni, Natale Calomino, Franco Roviello, Department of Oncology, Azienda Ospedaliera Universitaria Senese, Siena 53100, Tuscany, Italy
Author contributions: Marrelli D, Carbone L, Poto GE, Fusario D, Gjoka M, Andreucci E, Piccioni SA, Calomino N, Sandini M, and Roviello F contributed to the study conception, and design; Marrelli D, Carbone L, and Poto GE contributed to the material preparation and data collection; Marrelli D, Carbone L, and Fusario D wrote the first draft of the manuscript; Gjoka M designed the figure; All authors provided comments on previous versions of the manuscript and read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniele Marrelli, MD, Professor, Department of Medicine Surgery and Neuroscience, University of Siena, Via Banchi di Sotto 55, Siena 53100, Tuscany, Italy. daniele.marrelli@ao-siena.toscana.it
Received: December 9, 2024 Revised: March 19, 2025 Accepted: March 20, 2025 Published online: June 15, 2025 Processing time: 188 Days and 11.3 Hours
Abstract
Gastrectomy is the cornerstone of treatment for gastric cancer. Since the introduction of minimally invasive techniques, the main challenge for surgeons has been to achieve the same surgical radicality, adequate lymphadenectomy, and negative resection margins as with the open approach. Previous Eastern trials showed non-inferiority of laparoscopic gastrectomy, whereas Western trials reported a higher number of complications. This may depend on the different eligibility criteria to select patients and surgeons. Currently, the increased availability of robotic systems has led to renewed enthusiasm. We present a critical review of published randomized control trials (up to October 2024) to investigate the real benefits of robotic compared to open and laparoscopic approaches. Robotic gastrectomy has shown similar oncological outcomes in survival and lymph node retrieval, particularly in suprapancreatic stations, with the advantage of a more acceptable rate of pancreatic fistula and feasible anastomotic reconstruction. Some clinical situations, such as postchemotherapy interstitial fibrosis and distortion of anatomical planes, may increase the technical difficulty. Only four published trials assessed the implications of a pre-operative therapy, with no robotic surgery cases. Robotic systems may reduce intraoperative blood loss, the risk of conversion and allow more extensive lymphadenectomies in cancers with a high risk of extraperigastric metastases, or with clinically proven para-aortic node metastases, although clinical trials evaluating robotic gastrectomy after neoadjuvant therapy have not yet been published.
Core Tip: Robotic gastrectomy is likely to become the way forward for treating gastric cancer. It offers technical advantages in terms of lower rate of intraoperative blood loss and postoperative complications, with comparable survival and lymph node retrieval to open surgery. Our systematic review of randomized control trials analyzes the potential benefits of robotic systems, sheds light on the remaining uncertainties, and outlines future lines of research. Further evidence is needed to confirm its advantages in postneoadjuvant cases.
