Robot-assisted gastrectomy for cancer

Minimally invasive approach for gastric cancer has gained increasing acceptance. Introduction of the da Vinci robotic system has allowed overcoming the technical limitations of standard laparoscopy. To date, several studies have been published reporting the feasibility of robot-assisted gastrectomy (RAG). The aim of this study is to extensively review all the published literature concerning RAG and to assess its value. Since 2003, this systematic review of the literature shows that 10 original studies reporting 199 RAG for cancer have been published worldwide. The authors analyzed operative time, blood loss, conversion rate, lymph nodes retrieval, complications, mortality, length of hospital stay and follow-up through a systematic review. Mean age was 63 years (range: 25-96). Mean operative times were 265 minutes and 334 minutes for total and subtotal gastrectomy respectively. Mean blood loss reported was 113 mL (range: 12-1400). Conversion rate was 2.5%. Average lymph nodes retrieval was 32 (range: 11-83). Twenty-nine complications were reported (14.6%). Mortality rate was 1.5%. Mean length of stay was 10 days (range: 3-175).This review demonstrates that RAG for cancer is not only feasible but also seems to be safe, with low mortality and acceptable morbidity. However, due to the lack of long-term follow-up and the limited number of published studies, it is relatively too early to draw definitive conclusions and/or to recommend the use of RAG for oncologic gastrectomy. Randomized controlled trials with long-term follow up are needed before this promising approach can eventually be generalized.