How to Decide about Robotic Surgery in Patients with Locally Advanced Gastric Cancer?

Aim: Surgery is the cornerstone in the treatment of gastric cancer and includes conventional open gastrectomy and minimally invasive techniques. Preoperative criteria should be established in order to decrease the rate of conversion to open surgery. To evaluate such criteria, we must focus on computer tomography and upper endoscopy workup. Methods: This is a hospital-based observational retrospective study including 205 patients treated in Fundeni Clinical Institute, during the interval of 2008-2014. The patients were diagnosed with advanced gastric cancer according to endoscopic, computer-tomographic and histopathologic techniques. None of the patients received any neoadjuvant chemotherapy. 144 of patients underwent a curative surgical resection with D2 lymphadenectomy. Results: Minimally invasive surgery was performed on 51 patients; other 26 patients were initially treated by MIS but during operation they were converted to open surgery. Open surgery was performed on 128 patients. Risk factors that led to converting an initially MIS intervention to open intervention comprise: Borrmann 1 (p=0.0275) identified by endoscopy, metastasis (p=0.0416), peritoneal carcinomatosis (p=0.0156) identified by CT scan. On the contrary, endoscopic staging Borrmann 3 proved to be a preventing factor against surgical conversion (p=0.0169). Conclusion: A multivariate analysis of all prospective clinical, endoscopic and tomographic parameters is required to identify the patients with gastric cancer that could benefit more from the robotic platform. Endoscopic parameters as the distance from cardia, distance to pylorus, the invasion of more than one gastric wall, the invasion of both vertical and horizontal portion, might constitute criteria for the selection of surgical methods.