Zusammenfassung
Hintergrund
Die laparoskopische Gastrektomie beim Karzinom wird als anspruchsvolles Verfahren angesehen. Nachteile der Laparoskopie können mithilfe der Robotertechnik bereinigt werden, die die Ausführung aufwendiger Rekonstruktionen und feiner Dissektionen erleichtern kann. Diese hilft insbesondere bei der Durchführung der Lymphadenektomie.
Ziel der Arbeit
Es soll die von uns verwendete Technik bei der roboterassistierten Gastrektomie dargestellt und Vor- und Nachteile anhand eines aktuellen Literaturreviews diskutiert werden.
Material und Methoden
Wir beschreiben unsere Technik der roboterassistierten distalen und totalen Gastrektomie beim Karzinom. Des Weiteren beurteilen wir den gegenwärtigen Stand der Literatur zu Kurzzeitergebnissen, sofort auswertbaren onkologischen Parametern und onkologischem Langzeit-Ergebnis der roboterassistierten Gastrektomie im Vergleich zur konventionellen laparoskopischen und offenen Chirurgie.
Ergebnisse
Das Roboterverfahren scheint ebenso sicher und effektiv wie konventionelle Gastrektomieverfahren beim Magenkarzinom – jedoch geht es mit einer längeren Operationszeit, aber dafür geringerem Blutverlust als die laparoskopische Gastrektomie einher.
Schlussfolgerung
Die technischen Vorteile, die der Einsatz des Roboters mit sich bringt, könnten dazu beitragen die minimalinvasive D2-Lymphadenektomie zu standardisieren und routinemäßig anzuwenden. Obwohl Langzeitergebnisse bzgl. der Überlebenszeiten noch rar sind, sind die erzielten Ergebnisse bei den sofort auswertbaren onkologischen Parametern (Anzahl der entfernten Lymphknoten und Status am Absetzungsrand) sehr ermutigend. Es sind noch weitere Studien zur Untersuchung des langzeitonkologischen Ergebnisses erforderlich.
Abstract
Background
Laparoscopic gastrectomy for cancer is commonly considered a challenging procedure. The technical drawbacks of laparoscopy have been addressed by robotic technology, which can facilitate demanding reconstructions and fine dissection. These features confer potential advantages in the execution of lymphadenectomy.
Objectives
Here, we illustrate our technique of robotic gastrectomy and discuss advantages and drawbacks by reviewing the current literature.
Materials and methods
We describe our technique for robot-assisted distal and total gastrectomy for cancer and assess the current literature dealing with short-term outcomes, immediate oncologic measures, and long-term oncologic outcomes of robot-assisted gastrectomy, in comparison with conventional laparoscopic and open surgery.
Results
The robotic procedure seems to be as safe and effective as conventional gastrectomy for gastric cancer, with a longer operative time and decreased blood loss in comparison with laparoscopic gastrectomy.
Conclusion
The technical advantages offered by robotics could help to standardize minimally invasive D2 lymphadenectomy and enable surgeons to perform this procedure routinely. Despite the scarcity of long-termdata on survival, immediate oncological measures (lymph node yield and margin status) are encouraging. Further studies investigating the long-term oncological outcomes are required.
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S. Amore Bonapasta, F. Guerra, C. Linari, M. Annecchiarico, B. Boffi, M. Calistri und A. Coratti geben an, dass kein Interessenkonflikt besteht.
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Übersetzt von: PD Dr. Hermann Kißler, Oberarzt der Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena
Die englische Version dieses Beitrags ist unter doi:10.1007/s00104-016-0209-y zu finden.
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Amore Bonapasta, S., Guerra, F., Linari, C. et al. Roboterassistierte Magenresektion beim Karzinom. Chirurg 87, 643–650 (2016). https://doi.org/10.1007/s00104-016-0237-7
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DOI: https://doi.org/10.1007/s00104-016-0237-7