Abstract
Background
Robotic surgery is evolving as a therapeutic tool for thoracic and urologic applications; however, its use in gastric cancer surgery has not been extensively reported. The objective of this pilot series was to assess the feasibility of using robotic surgery in performing an extended lymphadenectomy for gastric cancer.
Methods
Between June 2005 and July 2006, seven patients (3 female, 4 male) underwent combined laparoscopic subtotal gastrectomy with omentectomy and robot-assisted extended lymphadenectomy using the da Vinci® Surgical System for early distal gastric tumors. The mean age of the patients was 64 years. Tumor staging ranged from 0 to II. Six patients had adenocarcinoma and one patient had a high-grade dysplastic adenoma.
Results
All procedures were completed successfully without conversion. The median operating time was 420 min. There was one intraoperative complication requiring a colon resection for a devascularized segment. The median number of nodes harvested was 24 (range = 17–30). Resection margins were negative in all specimens. Patients were hospitalized a median of 4 days (range = 3–9). Thirty-day mortality was 0%. Patients resumed a solid diet a median of 4 days postoperatively. Median followup was 9 (range = 0–10) months. There have been no tumor recurrences to date.
Conclusion
Extended lymphadenectomy for gastric cancer using robotic surgery is safe and allows for an adequate lymph node retrieval. Our preliminary results suggest that this novel technique offers short hospital stays and low morbidity for patients undergoing surgical resection of distal gastric malignancies. Future studies will be necessary to better define the role of robotic surgery in gastric cancer treatment.
Similar content being viewed by others
References
Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S ( 2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135: 806–810
Asao T, Hosouchi Y, Nakabayaski T, Haga N, Mochiki E, Kuwano H (2001) Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br J Surg 88: 128–132
Bonenkamp J, Hermans J, Sasako, Van De Velde C, for the Dutch Gastric Cancer Group (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340: 908–914
Carboni F, Lepiane P, Santoro R, Mancini P, Lorusso R (2005) Laparoscopic surgery for gastric cancer: preliminary experience. Gastric Cancer 8: 75–77
Cushieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook R, for the Surgical Cooperative Group (1996) Post-operative morbidity and mortality after D1 and D2 resections for gastric cancer; preliminary results of the MRC randomized controlled surgical trial. Lancet 347: 995–999
Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayer P, for the Surgical Cooperative Group (1999) Patient survival after D1, and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer 79: 1522–1530
Giulianotti P, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery. Arch Surg 138: 777–784
Goh P, Khan A, So J, Lomanto D, Cheah W, Muthiah R, Gandhi A (2001) Early experience with laparoscopic radical gastrectomy for advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 11: 83–87
Han H, Kim Y, Yi N, Fleisher G (2003) Laparoscopy-assisted D2 subtoal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech 13: 361–365
Hartgrink H, Van de Velde C, Putter H, Bonenkamp J, Kranebarg E, Songun I, Welvaart K, van Krieken J, Plukker J, van Elk P, Obertop H, Gouma D, van Lanschot J, Taat C, deGraaf P, von Meyenfeldt M, Tilanus H, Sasako M (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized dutch gastric cancer group trial. J Clin Oncol 22: 2069–2077
Hashizume M, Sugimachi K (2003) Robot-assisted gastric surgery. Surg Clin North Am 83: 1429–1444
Hashizume M, Shimada M, Tomikawa M, Ikeda Y, Takahashi I, Abe R, Koga F, Gotoh N, Konishis K, Maehara S, Sugimachi K (2002) Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc 16: 1187–1191
Huscher C, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastectomy for distal gastric cancer; five-year results of a randomized prospective trial. Ann Surg 241: 232–237
Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1: 10–24
Kaul S, Menon M (2006) Robotic radical prostatectomy: evolution from conventional to VIP. World J Urol 24: 152–160
Kim M, Kim K, Kim Hyung, Jung G (2005) Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91: 90–94
Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y (2002) Laparoscopy-assisted Billroth-I gastrectomy for cancer: our 10 years’ experience. Surg Laparosc Endosc Percutan Tech 12: 204–207
Kypson A, Chitwood WR (2006) Robotic cardiovascular surgery. Expert Rev Med Devices 3: 335–343
Lanfranco A, Castellanos A, Desai J, Meyers W (2004) Robotic surgery: a current perspective. Ann Surg 239: 14–21
Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Asao T, Kuwano H (2005) Laparscopic assisted distal gastrectomy for early gastric cancer: Five years’ experience. Surgery 137: 317–322
Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari G, DiLernia S, Costanzi A, Pauna J, DeMartini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarinoma. Surg Endosc 21: 21–27
Reyes C, Weber K, Gagner M, Divino C (2001) Laparoscopic vs open gastrectomy. Surg Endosc 15: 928–931
Roukos D, Lorenz M, Encke A (1998) Evidence of survival benefit of (D2) lymphadenectomy in Western patients with gastric cancer based on a new concept: A prospective long-term follow-up study. Surgery 123: 573–578
Shimizu S, Uchiyama A, Mizumota K, Morisake T, Nakamura K, Shimura H, Tanaka M (2000) Laparoscopically assisted distal gastrectomy for early gastric cancer. Surg Endosc 14: 27–31
Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 17: 758–762
Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H (2007) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 94: 204–207
Uyama I, Sugioika A, Fujita J,Komori Y, Matsui H, Soga R, Wakayama A, Okamota K, Ohyama A, Hasumi A (1999). Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 2: 186–190
Uyama I, Sugioka A, Fujita J, Yoskiyuki K, Hideo M, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2: 230–234
Wu C, Hsiung C, Lo S, Hsieh M, Chen J, Li A, Lui W, Whang-Peng J (2006) Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 7: 309–315
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Anderson, C., Ellenhorn, J., Hellan, M. et al. Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc 21, 1662–1666 (2007). https://doi.org/10.1007/s00464-007-9266-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9266-0