Gastric Cancer: Partial, Subtotal, and Total Gastrectomies/Lymph Node Dissection for Gastric Malignancies
Robotic surgery is a successful approach to the management of curable patients with gastric cancer. Many gastric cancer surgeons have adopted robotic technology to assist them in the technically challenging procedure of gastrectomy with lymphadenectomy. R
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Gastric Cancer: Partial, Subtotal, and Total Gastrectomies/Lymph Node Dissection for Gastric Malignancies Woo Jin Hyung and Yanghee Woo
Introduction
Indications
The management of gastric cancer patients requires a multidisciplinary approach with surgery, the mainstay of curative treatment. Radical gastric resection and appropriate lymphadenectomy is the standard of care. Operative procedures for gastric cancer can be technically challenging especially as minimally invasive approaches. Many gastric cancer surgeons have adopted robotic technology to assist them in the technically challenging procedure of gastrectomy with - lymphadenectomy [1–4]. With additional robotic surgery training, experienced laparoscopic gastric cancer surgeons can safely provide the advantages of minimally invasive surgery to their patients. Adherence to the oncologic principles of gastric cancer treatment can assure the patients that the long-term survival benefits of surgery will not be compromised.
Robotic surgery can be applied to those gastric cancer operations where conventional laparoscopic approach is indicated [5–10]. Currently, minimally invasive surgery is most commonly performed for early gastric cancer patients without perigastric lymph node (LN) involvement, and these patients are good candidates for robotic gastrectomy with limited lymphadenectomy. This is based on the recommendations of the Japanese gastric cancer treatment guidelines and classification [11, 12]. However, robotic technology may be most ideal for patients with locally advanced gastric cancer without evidence of distant metastases that require gastrectomy and D2 lymphadenectomy since robotic surgery provides the advantages of increase dexterity of movement for more precise dissection along the vessels during retrieval of perivascular soft tissues containing N2 lymph nodes [5]. Indications for robotic gastrectomy with limited lymphadenectomy: • Stage IA (cT1N0M0) by 7th AJCC TNM classification • Mucosal and submucosal tumors not eligible for endoscopic resection • Failed endoscopic mucosal resection or endoscopic submucosal dissection Indications for robotic gastrectomy requiring D2 lymphadenectomy: • Stage IB (cT1N1M0; cT2N0M0) • Stage IIA (cT2N1M0)
W.J. Hyung, M.D., Ph.D. (*) Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Republic of Korea e-mail: [email protected] Y. Woo, M.D. Division of GI/Endocrine Surgery, Center for Excellence in Gastric Cancer Care, Columbia University Medical Center, New York, NY, USA Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA Department of Surgery, New York Presbyterian Hospital, New York, NY, USA e-mail: [email protected]
K.C. Kim (ed.), Robotics in General Surgery, DOI 10.1007/978-1-4614-8739-5_9, © Springer Science+Business Media New York 2014
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At this time, no evidence is available to support robotic surgery for serosa-positive tumors (T4a) or tumors which have invaded adjacent organs (T4b) nor for palliativ
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