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Robot-assisted gastrectomy for cancer

Roboterassistierte Magenresektion beim Karzinom

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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-term data on survival, immediate oncological measures (lymph node yield and margin status) are encouraging. Further studies investigating the long-term oncological outcomes are required.

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.

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References

  1. Chuan L, Yan S, Pei-Wu Y (2015) Meta-analysis of the short-term outcomes of robotic-assisted compared to laparoscopic gastrectomy. Minim Invasive Ther Allied Technol 24(3):127–134. doi:10.3109/13645706.2014.98568

    Article  PubMed  Google Scholar 

  2. Coratti A, Annecchiarico M, Di Marino M et al (2013) Robot-assisted gastrectomy for gastric cancer: current status and technical considerations. World J Surg 37:2771–2281. doi:10.1007/s00268-013-2100-z

    Article  PubMed  Google Scholar 

  3. Coratti A, Fernandes E, Lombardi A, Di Marino M, Annecchiarico M, Felicioni L, Giulianotti PC (2015) Robot-assisted surgery for gastric carcinoma: five years follow-up and beyond: A single western center experience and long-term oncological outcomes. Eur J Surg Oncol 41(8):1106–1113. doi:10.1016/j.ejso.2015.01.014.

    Article  CAS  PubMed  Google Scholar 

  4. D’Annibale A, Pende V, Pernazza G et al (2010) Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results. J Surg Res 166:113–120. doi:10.1016/j.jss.2010.11.881

    Article  Google Scholar 

  5. Diana M, Marescaux J (2015) Robotic surgery. Br J Surg 102(2):15–28. doi:10.1002/bjs.9711

    Article  Google Scholar 

  6. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784

    Article  PubMed  Google Scholar 

  7. Hashizume M, Sugimachi K (2003) Robot-assisted gastric surgery. Surg Clin North Am 83:1429–1444

    Article  PubMed  Google Scholar 

  8. Huang KH, Lan YT, Fang WL, Chen JH, Lo SS et al (2014) Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS ONE 9(10):e111499 doi:10.1371/journal.pone.0111499

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hur H, Kim JY, Cho YK, Han SU (2010) Technical feasibility of robot-sewn anastomosis in robotic surgery for gastric cancer. J Laparoendosc Adv Surg Tech A 20:693–697. doi:10.1089/lap.2010.0246

    Article  PubMed  Google Scholar 

  10. Hyun MH, Lee CH, Kim HJ et al (2013) Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma. Br J Surg 100:1566–1578. doi:10.1002/bjs.9242

    Article  CAS  PubMed  Google Scholar 

  11. Hyun MH, Lee CH, Kwon YJ et al (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20:1258–1265. doi:10.1245/s10434-012-2679-6

    Article  PubMed  Google Scholar 

  12. Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z, Yongliang Z, Feng Q, Peiwu Y (2011) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer:comparison of surgical performance and short-term outcomes. Surg Endosc 28(6):1779–1787. doi:10.1007/s00464-013-3385-6

    Article  Google Scholar 

  13. Kim KM, An JY, Kim HI et al (2012) Major early complications following open, laparoscopic and robotic gastrectomy. Br J Surg 99:1681–1687. doi:10.1002/bjs.8924

    Article  CAS  PubMed  Google Scholar 

  14. Kitano S, Iso Y, Moriyama M, Surgimachi K (1994) Laparoscopy assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    CAS  PubMed  Google Scholar 

  15. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:306–S311

    Article  Google Scholar 

  16. Lee J, Kim YM, Woo Y, Obama K, Noh SH, Hyung WJ (2015) Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc 29:3251–3260. doi:10.1007/s00464-015-4069-1

    Article  PubMed  Google Scholar 

  17. Liu XX, Jiang ZW, Chen P, Zhao Y, Pan HF, Li JS (2013) Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes. World J Gastroenterol 19(38):6427–6437. doi:10.3748/wjg.v19.i38.6427

    Article  PubMed  PubMed Central  Google Scholar 

  18. Moisan F, Norero E, Slako M, Varas J, Palominos G, Crovari F, Ibañez L, Pérez G, Pimentel F, Guzmán S, Jarufe N, Boza C, Escalona A, Funke R (2012) Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc 26:661–672. doi:10.1007/s00464-011-1933-5

    Article  PubMed  Google Scholar 

  19. Patriti A, Ceccarelli G, Bellochi R, Bartoli A, Spaziani A, Di Zitti L, Casciola L (2008) Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma. Surg Endosc 22:2753–2760. doi:10.1007/s00464-008-0129-0

    Article  PubMed  Google Scholar 

  20. Pugliese R, Maggioni D, Sansonna F et al (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5‑year survival. Surg Endosc 24:2594–2602. doi:10.1007/s00464-010-1014-1

    Article  PubMed  Google Scholar 

  21. Shen WS, Xi HQ, Chen L, Wei B (2014) A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc 28(10):2795–2802. doi:10.1007/s00464-014-3547-1

    Article  PubMed  Google Scholar 

  22. Son T, Lee JH, Kim YM, Kim HI, Noh SH, Hyung WJ (2014) Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 28(9):2606–2615. doi:10.1007/s00464-014-3511-0

    Article  PubMed  Google Scholar 

  23. Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH (2009) Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc 23:1204–1211. doi:10.1007/s00464-009-0351-4

    Article  PubMed  Google Scholar 

  24. Song J, Oh SJ, Kang WH et al (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 249:927–932. doi:10.1097/01.sla.0000351688.64999.73

    Article  PubMed  Google Scholar 

  25. Suda K, Man-I M, Ishida Y, Kawamura Y, Satoh S, Uyama I (2015) Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 29(3):673–685. doi:10.1007/s00464-014-3718-0

    Article  PubMed  Google Scholar 

  26. Terashima M, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Miki Y, Makuuchi R, Honda S, Tatsubayashi T, Takagi W, Omori H, Hirata F (2015) Robotic surgery for gastric cancer. Gastric Cancer 18:449–457. doi:10.1007/s10120-015-0501-4

    Article  PubMed  Google Scholar 

  27. Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, Noh SH (2011) Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg 146:1086–1092. doi:10.1001/archsurg.2011.114

    Article  PubMed  Google Scholar 

  28. Xiong B, Ma L, Zhang C (2012) Robotic versus laparoscopic gastrectomy for gastric cancer: a meta-analysis of short outcomes. Surg Oncol 21:274–280. doi:10.1016/j.suronc.2012.05.004

    Article  PubMed  Google Scholar 

  29. Zhou J, Shi Y, Qian F, Tang B, Hao Y, Zhao Y, Yu P (2015) Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol 111(6):760–767. doi:10.1002/jso.23876

    Article  PubMed  Google Scholar 

  30. Zong L, Seto Y et al (2014) Efficacy evaluation of subtotal and total gastrectomies in robotic surgery for gastric cancer compared with that in open and laparoscopic resections: a meta-analysis. PLoS ONE 9(7):e103312 doi:10.1371/journal.pone.0103312

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Oncological and Robotic General Surgery, Careggi University Hospital, 50134, Florence, Italy

    S. Amore Bonapasta, F. Guerra, C. Linari, M. Annecchiarico, B. Boffi, M. Calistri & A. Coratti

Authors
  1. S. Amore Bonapasta
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  2. F. Guerra
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  3. C. Linari
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  4. M. Annecchiarico
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  5. B. Boffi
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  6. M. Calistri
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  7. A. Coratti
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Corresponding author

Correspondence to S. Amore Bonapasta.

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Conflict of interest

S. Amore Bonapasta, F. Guerra, C. Linari, M. Annecchiarico, B. Boffi, M. Calistri, and A. Coratti state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Additional information

The German version of this article can be found under doi:10.1007/s00104-016-0237-7.

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Amore Bonapasta, S., Guerra, F., Linari, C. et al. Robot-assisted gastrectomy for cancer. Chirurg 88 (Suppl 1), 12–18 (2017). https://doi.org/10.1007/s00104-016-0209-y

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