ABSTRACT
ABSTRACT Introduction: Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. Objective: To evaluate and summarize the current status of minimally invasive resection of gastric cancer. Methods: A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. Results: 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Conclusion: Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale.
RESUMO Introdução: A cirurgia minimamente invasiva amplamente usada para tratar doenças benignas do aparelho digestivo, tornou-se o foco de intenso estudo nos últimos anos no campo da oncologia cirúrgica. Desde então, a experiência com este tipo de abordagem tem crescido, com o objetivo de fornecer os mesmos resultados oncológicos e sobrevivência à cirurgia convencional. Em relação ao câncer gástrico, o tratamento cirúrgico ainda é considerado o único tratamento curativo, considerando a extensão da ressecção e linfadenectomia realizada. A gastrectomia convencional continua a ser a principal modalidade realizada em todo o mundo. Não obstante, o papel do acesso minimamente invasivo tem ainda de ser esclarecido. Objetivo: Avaliar e resumir o estado atual da ressecção minimamente invasiva do câncer gástrico. Método: Foi realizada revisão da literatura utilizando as bases Medline/PubMed, Cochrane Library e SciELO com os seguintes descritores: câncer gástrico, cirurgia minimamente invasiva, gastrectomia robótica, gastrectomia laparoscópica, neoplasia de estômago. A língua usada para a pesquisa foi o inglês. Resultados: Foram considerados para elaboração desta revisão 28 artigos, entre eles ensaios clínicos randomizados, metanálises, estudos coorte prospectivos e retrospectivos. Conclusão: A gastrectomia minimamente invasiva é opção técnica no tratamento do câncer gástrico precoce. Quanto ao câncer avançado, estudos recentes têm demonstrado a segurança e a viabilidade do acesso videolaparoscópico. A gastrectomia robótica provavelmente melhorará os resultados obtidos com a laparoscopia. Porém, o alto custo ainda é impedimento para sua utilização em larga escala.
Subject(s)
Humans , Stomach Neoplasms/surgery , Gastrectomy/methods , Stomach Neoplasms/pathology , Minimally Invasive Surgical Procedures , Robotic Surgical Procedures , Gastrectomy/standards , Neoplasm StagingABSTRACT
PURPOSE: The aim of this study was to compare the outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for surgical treatment of patients with gastric cancer. METHODS: Patients who underwent RG (study group) between December 2007 and December 2011 were enrolled in the study, and patients who underwent LG (control group) during the same period were matched for age, gender, and co-morbidity. Analysis of clinicopathological data, operative data, postoperative morbidity, and pathologic data was performed. RESULTS: Twenty one RG patients (study group) and 42 LG patients (control group) were enrolled in the study. The mean age of patients in the RG group was 52.3 years, and the ratio of male to female was 14 : 7. Nineteen distal gastrectomies (90.4%), one total gastrectomy (4.8%), and one proximal gastrectomy (4.8%) were performed in the RG group. A longer mean operative time (267.2 [range, 170~360] vs. 166.7 [range, 95~275] min, p<0.001) and more estimated blood loss (173.2 vs. 116.6 ml, p=0.014) were observed in the RG group; however, no difference in the mean numbers of harvested lymph nodes (39.7 vs. 46.5, p=0.063), duration of hospital stay (6.4 vs. 5.9 day, p=0.508), and early complication rate (9.6% vs. 4.8%, p=0.416) was observed between the two groups. CONCLUSION: In our experience, RG with lymphadenectomy for treatment of early gastric cancer is technically feasible. However, compared with LG, longer operative time and more estimated blood loss was observed with RG, while no difference was observed in numbers of harvested lymph nodes and length of hospital stay.
Subject(s)
Female , Humans , Male , Case-Control Studies , Gastrectomy , Length of Stay , Lymph Node Excision , Lymph Nodes , Operative Time , Stomach NeoplasmsABSTRACT
PURPOSE: To assess the feasibility of the da Vinci(R) surgical system in performing gastrectomies for gastric cancer. METHODS: Between 31 December 2007 and 30 June 2008, twenty patients underwent robotic gastrectomies using the da Vinci(R) surgical system for gastric cancer. Retrospectively, clinicopathologic and postoperative surgical outcomes were retrieved from the Stomach Cancer Database at Dong-A University Medical Center. RESULTS: Two patients with serosa invasion required conversion to laparotomy. Seventeen robotic distal gastrectomies and one robotic total gastrectomy were performed. Most patients underwent D1+beta or D2 lymph node dissection. The average number of retrieved lymph nodes was 41. Mean operative time was 271 minutes. Estimated blood loss was 30 ml and mean postoperative hospital stay was 5.1 days. No postoperative complications were reported. CONCLUSION: While application of robotic technology for gastric cancer is technically feasible, problems of long operative times and extremely high costs remain. More randomized studies comparing long-term surgical outcomes between robotic, conventional open, and laparoscopic surgery are needed.