Abstract
Introduction:
Widespread diffusion of minimally invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended D2-lymphadenectomy. 1 –4 This surgical step can be facilitated by robot-assisted surgery. 5 –11 Herein we present a video of a subtotal gastrectomy with D2-lymphadenectomy for gastric cancer of the body-antrum, according to the Japanese Research Society for Gastric Cancer Guidelines. 1,5
Materials and Methods:
Between May 2004 and May 2011, we performed 37 consecutive full robot-assisted total and subtotal gastrectomies with extended D2-lymphadenectomy for histologically proven gastric adenocarcinoma.
Results and Conclusions:
Mean body–mass index was 25.7±5.7 (range, 21.4–31.9). Median operative time was 267.50 minutes (range, 255–305). Median intraoperative blood loss was 30 mL. Median number of harvested lymph nodes was 28 (range, 23–34). Resection margins were negative in all cases. No conversions occurred. Surgery-related morbidity was 3/37 (8%): a left pleural collection and two asymptomatic leakages of the esophago-jejunostomy. The latter were diagnosed during a routinely postoperative contrast swallow and were conservatively treated. Thirty-day mortality was 0%. Liquid diet started on postoperative day 5 (2–5). Median length of stay was 6 days (range, 5–8). There were 11 patients with stage IA (29.7%), 5 patients with stage IB (13.5%), 6 patients with stage IIA (16.2%), 4 patients with stage IIB (10.8%), 5 patients with stage IIIA (13.5%), 2 patients with stage IIIB (5.4%), and 4 patient with stage IIIC (5.4%). Robot-assisted gastrectomy with D2-lymphadenectomy is a safe technique and allows for achievement of an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity. 5 –11 The learning curve appears to be shorter than in laparoscopic surgery. 5,12 Longer follow-up and randomized clinical trials are needed to define the role of robot assistance in gastric cancer surgery.
Dr. D'Annibale and co-authors reported no biomedical financial interest, commercial associations, or potential conflicts of interest
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Runtime of video: 9 mins 17 secs
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