[Minimally invasive and robotic gastrectomy]

Evidence from Asia demonstrates that minimally invasive gastrectomy can be safely performed for early-stage gastric cancer, with advantages at least in the early postoperative course; however, these data have limited transferability to Europe, where locally advanced stages predominate and are treated within multimodal concepts. Robotic-assisted systems have further expanded the technical spectrum.

Is minimally invasive or robotic gastrectomy safely feasible in Europe for locally advanced stages or does it remain a procedure for specialized centers?

Randomized trials confirm the oncological equivalence of laparoscopic gastrectomy with consistent perioperative advantages, at least for early stages of cancer. Asian studies also demonstrate benefits of minimally invasive procedures for locally advanced stages, whereas European data do not consistently confirm these advantages. For robotic gastrectomy, first randomized controlled trials (RCT) demonstrate comparable short-term outcomes; technical advantages are discussed particularly in anatomically demanding situations. Initial studies also suggest potential benefits of robotic over laparoscopic gastrectomy in terms of disease-free survival. The evidence derives predominantly from Asian cohorts with limited transferability to western patients.

In specialized centers with adequate case volumes, minimally invasive gastrectomy can today be safely performed even in locally advanced stages and as part of multimodal treatment concepts. Convincing evidence for the superiority of minimally invasive procedures does not, however, currently exist for this patient group. Robotic surgery complements the surgical spectrum; whether the oncological advantages suggested by initial studies will prove robust cannot be conclusively assessed at this time.