Chirurgia robotica versus open nel trattamento dell'adenocarcinoma gastrico

Aim Gastric cancer is the fifht most common neoplasia and the third cause of death for tumor.Surgical treatment is the only curative option and open surgery is still the most common approach, while laparoscopic treatment is limited to high volume and high experienced centres. Robotic surgery allows to overcome limits of laparoscopic surgery, by reproducing the same gesture of open surgery and standardizing complex oncologic procedures. The aim of this study is to evaluate the oncological efficacy and safety of robotic surgery for gastric cancer, compared to open surgery. Methods We collected in a prospective database all patients treated for gastric cancer in the Surgical Unit of San Donato Hospital in Arezzo, from October 2012 to July 2016. 133 received curative surgery (R0/R1). Among these, 92 patients are treated with open approach, while 41 underwent to robotic treatment. Patients are not randomized and we chose the treatment, open versus robotic, considering patients charateristics, clinical stadiation, ASA risk and surgeon’s experience. We then corrected the lack of randomization by using the statistical matching by Propensity Score. Results We use the system SPSS for statistical analysis. Robotic surgery is related to longer operative time (295 min vs 160, p<0,05). Both techniques offered oncological efficacy (negative margins 100% in both groups and harvested lymphnodes >15) but the number of harvested lymhpnodes is higher in robotic group (25 vs 19 p<0,05). At short term results analysis there are no differences in time to oral feeding and post-operative stay. Robotica is related to less operative blood loss and lower rate of transfusion. Mean time of oncological follow-up was 22 months. Kaplan-Meier curves of OS and RFS show no differences between the two groups. Conclusions Robotic approach is introduced for treatment of gastric cancer a decade ago only. International literature agrees in confering to robotic surgery same oncological results to open surgery and better post-operative outcomes. Our analysis shows a better trend in intraoperative blood loss and transfusions for robotic surgery. At medium-term follow-up we have no differences in Overal Survival e Recurrence Free Survival, confirming the appropriateness of robotic approach.