Robot-assisted laparoscopic subtotal gastrectomy for early-stage gastric cancer: Case series of initial experience

Fabio Ambrosini; Valerio Caracino; Diletta Frazzini; Pietro Coletta; Edoardo Liberatore; Massimo Basti

doi:10.1016/j.amsu.2020.12.026

Robot-assisted laparoscopic subtotal gastrectomy for early-stage gastric cancer: Case series of initial experience

Ann Med Surg (Lond). 2020 Dec 24:61:115-121. doi: 10.1016/j.amsu.2020.12.026. eCollection 2021 Jan.

Authors

Fabio Ambrosini¹, Valerio Caracino¹, Diletta Frazzini¹, Pietro Coletta², Edoardo Liberatore³, Massimo Basti¹

Affiliations

¹ Department of General and Emergency Surgery, St Spirito's Hospital of Pescara, 65124, Pescara, Italy.
² Department of General and Emergency Surgery, AOU Ospedali Riuniti of Ancona, 60020, Ancona, Italy.
³ Department of General Surgery, St Liberatore's Hospital of Atri, 64032, Teramo, Italy.

Abstract

Background: In the last decade's robotic gastrectomy (RG) has increasingly widespread as a valid minimally invasive option for treatment of gastric cancer. In literature, evidence of its routine use is not yet well established. The aims of this study are to report our initial experience and to present possible advantages of our hybrid operative technique for subtotal gastrectomy.

Materials and methods: Retrospectively, we analyzed data from 41 patients (22 male and 19 female) who underwent robot-assisted laparoscopic subtotal gastrectomy (RALG) with D2 lymphadenectomy using the da Vinci XI robotic system. Inclusion criteria were gastric cancer in the middle or lower portion of the stomach amenable of radical subtotal gastrectomy without preoperative suspicion of positive lymph-nodes or other organs involving and distant metastasis. All the procedures were performed by attending surgeons.

Results: The mean operative time was 270 min with one case of conversion to open surgery. The mean age was 71.4 (IQR 68.2-76.8) with 43.9% of patients classified as ASA (American Society of Anesthesiologists) score ≥3. The median of lymph-nodes retrieved was 25 (IQR 19-35). No intra-operative complications occurred. Time to resume a soft diet was 5 days. Patients were hospitalized a median of 7 days. According to pathological AJCC-TNM, 21 patients were classified as advanced gastric cancer. Post-operative morbidity was recorded in 9 patients (21.9%) with major complications requiring surgical operation in 4 patients (9.8%). Elevated ASA score, fewer lymph-nodes retrieved and ICU recovery requirements were significant increased in patients with major complications.

Conclusion: The preliminary results demonstrated that robot-assisted laparoscopic subtotal gastrectomy is safe and feasible. In particular, we found that the da Vinci platform improves surgeon abilities to perform an adequate lymphadenectomy and digestive reconstruction. Further studies are necessary to better clarify the role of this high-cost technology in minimally invasive treatment of gastric cancer.

Keywords: Case series; Distal gastrectomy; Gastric cancer; Minimally invasive surgery; Robot-assisted laparoscopic gastrectomy; Robotic surgery.