Minimally invasive surgical management of gastric malignancies: role of robotic surgery

Minimally invasive techniques for gastric resection have become more appealing to many patients and surgeons than open techniques due to their reduction in postoperative pain, hospital stay, and faster recovery. Endoscopic resection of early stage gastric cancer has become an attractive alternative to conventional surgery for very early gastric cancer. In the management of gastric malignancies, learning curves for laparoscopic gastrectomy have been met, and this technique has been implemented by surgeons all around the world. As regards robotic-assisted gastrectomy, this approach has shown non-inferiority in terms of oncological outcomes, but it's longer operation time and high costs imply major drawbacks. In the present article we discuss minimally invasive techniques for gastric surgery, as well as review the most recent studies comparing laparoscopic and robotic gastrectomy in the treatment of gastric cancer. Although the robot hasn’t met the desired expectations, it has shown several advantages over the laparoscopic approach, such as decreased blood loss, decreased hospital stay, decreased complications (pancreatic fistula), and increased number of harvested lymph nodes. To date, there are no results from well-designed randomised controlled trials comparing laparoscopic and robotic gastrectomy, and most studies on robotic gastrectomy come from Eastern hemisphere countries, who encounter early stage gastric cancer in low BMI patients. Contrary to this, Western countries encounter more advanced, cardia gastric cancer, in higher BMI patients, resulting in a technical challenge when surgery is indicated in these patients. We believe the real benefits of the robot will be determined in these more technically demanding cases.