Marrelli Daniele, Carbone Ludovico, Poto Gianmario Edoardo, Fusario Daniele, Gjoka Mattheus, Andreucci Eleonora, Piccioni Stefania Angela, Calomino Natale, Sandini Marta, Roviello Franco
Department of Medicine Surgery and Neuroscience, University of Siena, Siena 53100, Tuscany, Italy.
Department of Oncology, Azienda Ospedaliera Universitaria Senese, Siena 53100, Tuscany, Italy.
World J Gastrointest Oncol. 2025 Jun 15;17(6):104015. doi: 10.4251/wjgo.v17.i6.104015.
Gastrectomy is the cornerstone of treatment for gastric cancer. Since the introduction of minimally invasive techniques, the main challenge for surgeons has been to achieve the same surgical radicality, adequate lymphadenectomy, and negative resection margins as with the open approach. Previous Eastern trials showed non-inferiority of laparoscopic gastrectomy, whereas Western trials reported a higher number of complications. This may depend on the different eligibility criteria to select patients and surgeons. Currently, the increased availability of robotic systems has led to renewed enthusiasm. We present a critical review of published randomized control trials (up to October 2024) to investigate the real benefits of robotic compared to open and laparoscopic approaches. Robotic gastrectomy has shown similar oncological outcomes in survival and lymph node retrieval, particularly in suprapancreatic stations, with the advantage of a more acceptable rate of pancreatic fistula and feasible anastomotic reconstruction. Some clinical situations, such as postchemotherapy interstitial fibrosis and distortion of anatomical planes, may increase the technical difficulty. Only four published trials assessed the implications of a pre-operative therapy, with no robotic surgery cases. Robotic systems may reduce intraoperative blood loss, the risk of conversion and allow more extensive lymphadenectomies in cancers with a high risk of extraperigastric metastases, or with clinically proven para-aortic node metastases, although clinical trials evaluating robotic gastrectomy after neoadjuvant therapy have not yet been published.
胃切除术是胃癌治疗的基石。自从引入微创技术以来，外科医生面临的主要挑战一直是要达到与开放手术相同的手术根治性、充分的淋巴结清扫以及切缘阴性。先前的东方国家试验显示腹腔镜胃切除术并不逊色，而西方国家的试验则报告了更多的并发症。这可能取决于选择患者和外科医生的不同入选标准。目前，机器人系统可用性的提高引发了新的热潮。我们对已发表的随机对照试验（截至2024年10月）进行了批判性综述，以研究机器人手术与开放手术和腹腔镜手术相比的实际益处。机器人胃切除术在生存率和淋巴结清扫方面显示出相似的肿瘤学结果，尤其是在胰上区，其优势在于胰瘘发生率更易接受且吻合口重建可行。一些临床情况，如化疗后的间质纤维化和解剖层面的扭曲，可能会增加技术难度。仅有四项已发表的试验评估了术前治疗的影响，且没有机器人手术病例。机器人系统可能会减少术中失血、降低中转风险，并允许在胃周外转移风险高或经临床证实有主动脉旁淋巴结转移的癌症中进行更广泛的淋巴结清扫，尽管评估新辅助治疗后机器人胃切除术的临床试验尚未发表。
