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Schena CA, Luzzi AP, Laterza V, De Simone B, Aisoni F, Gavriilidis P, Catena F, Coccolini F, Morciano F, Rosa F, Marchegiani F, de'Angelis N. Gastrointestinal Stromal Tumors of the Stomach: Is There Any Advantage of Robotic Resections? A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:603-613. [PMID: 38962886 DOI: 10.1089/lap.2024.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background: The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs. Methods: MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023. Two independent reviewers conducted a systematic review of the literature to select all types of analytic studies comparing robotic versus laparoscopic surgery for GISTs and reporting intraoperative, postoperative, and/or pathological outcomes. Results: Overall, 4 retrospective studies were selected, including a total of 264 patients, specifically 111 (42%) in the robotic and 153 (58%) in the laparoscopic group. Robotic surgery was associated with longer operating time (+42.46 min; 95% confidence interval [CI]: 9.34, 75.58; P=0.01; I2: 85%) and reduced use of mechanical staplers (odds ratio [OR]: 0.05; 95%CI: 0.02, 0.11; P<0.00001; I2: 92%;) compared with laparoscopy. Although nonsignificant, conversion to open surgery was less frequently reported for robotic surgery (2.7%) than laparoscopy (5.2%) (OR: 0.59; 95%CI: 0.17, 2.03; P=0.4; I2: 0%). No difference was found for postoperative and oncological outcomes. Conclusions: Robotic surgery for gastric GISTs provides similar intraoperative, postoperative, and pathological outcomes to laparoscopy, despite longer operative time.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Andrea-Pierre Luzzi
- Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Università di Genova, Genoa, Italy
| | - Vito Laterza
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Filippo Aisoni
- Unit of Emergency Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust,, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Francesca Morciano
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Nicola de'Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Jian C, Huang X, Lin R, Yang W, Zheng S, He H, Jin S, Yang C, Guan S. Robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) for the treatment of gastric gastrointestinal stromal tumors in challenging anatomical locations: single-center experience. Front Surg 2024; 11:1391387. [PMID: 38846924 PMCID: PMC11153673 DOI: 10.3389/fsurg.2024.1391387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/17/2024] [Indexed: 06/09/2024] Open
Abstract
Background Gastric gastrointestinal stromal tumors in challenging anatomical locations are difficult to remove. Methods This study retrospectively analyzed the clinical data of 12 patients with gastric GISTs in challenging anatomical locations who underwent robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) and manual suturing of the gastric wall. Results This study included 12 patients with a mean age of 56.8 ± 9.8 years and a mean BMI of 23.9 ± 1.9 kg/m2. Tumors were located in the GEJ (n = 3), lesser curvature (n = 3), posterior gastric wall (n = 3) and antrum (n = 3). The cardia and pylorus were successfully preserved in all patients regardless of the tumor location. The mean tumor size was 4.5 ± 1.4 cm. The mitotic-count/50 mm2 was less than 5 in all patients (100%). There was no intraoperative tumor rupture (0%) and no conversion to open surgery (0%). The median operation time was 122 (97-240) min, and the median blood loss volume was 10 (5-30) ml. The median postoperative VAS score was 2 (2-4). The median time to first flatus was 2 (2-3) days. The median time to first fluid intake was 2 (2-3) days. The median time to first ambulation after the operation was 3 (2-4) days. No cases of anastomotic stenosis or leakage were found. The median time to drain removal for 6 patients was 5 (4-7) days. The median time to nasogastric tube removal for all patients was 2 (1-5) days. The median postoperative hospital stay was 5 (4-8) days. One patient (female/41 year) developed moderate anemia (Clavien-Dindo grade II complication). There was no unplanned readmission within 30 days after the operation. The median distance from the tumor to the resection margin was 1 (1-2) cm. R0 resection was achieved in all patients. The median follow-up period was 19 (10-25) months, and all patients survived with no recurrence or metastasis. Conclusions RALE-PG is a safe, feasible and advantageous technique for treating GISTs in challenging anatomical locations. It can be used to accurately remove the tumor while preserving gastric function to the greatest extent, but long-term oncologic outcomes need to be evaluated in a study with a larger sample size and longer follow-up period.
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Affiliation(s)
- Chenxing Jian
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Department of Anorectal Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Xinxiang Huang
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Ruirong Lin
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Weijin Yang
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shiyao Zheng
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Hongxin He
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shangkun Jin
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Chunkang Yang
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shen Guan
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Lwin TM, Fong ZV, Narayan RR, Wang SJ, Wang J. Robotic Function-Preserving Resection of Gastric Gastrointestinal Stromal Tumor. J Surg Res 2023; 290:164-170. [PMID: 37269799 DOI: 10.1016/j.jss.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Gastric gastrointestinal stromal tumors (GISTs) located at the gastroesophageal junction (GEJ), lesser curvature, posterior gastric wall, or antrum present challenges for gastric function preservation. The aim of this study was to evaluate safety and effectiveness of robot-assisted resection of gastric GIST in challenging anatomic locations. METHODS This was a single-center case series of robotic gastric GIST resections in challenging anatomic locations performed from 2019 to 2021. GEJ GISTs are defined as tumors within 5 cm of the GEJ. Location of the tumor and distance from the GEJ were determined from the endoscopy report and/or cross-sectional imaging and operative findings. RESULTS There were 25 consecutive patients who underwent a robot-assisted partial gastrectomy for a gastric GIST in challenging anatomic locations. Tumors were located at the GEJ (n = 12), lesser curvature (n = 7), posterior gastric wall (n = 4), fundus (n = 3), greater curvature (n = 3), and antrum (n = 2). Median distance of tumor from GEJ was 2.5 cm. Both GEJ and pylorus were successfully preserved in all patients regardless of tumor location. Median operative time was 190 min with a median estimated blood loss of 20 mL and no conversion to open approach. Median hospital stay was 3 d with solid diet intake starting 2 d after surgery. Two (8 %) patients had Grade III or higher postoperative complications. Median tumor size upon resection was 3.9 cm. Negative margins were obtained in 96.3%. There was no evidence of recurrent disease with a median follow-up of 11.3 mo. CONCLUSIONS We demonstrate the safety and feasibility of using the robotic approach to facilitate function preservation gastrectomy in challenging anatomic locations without compromising oncologic resection.
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Affiliation(s)
- Thinzar M Lwin
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, California; Division of Surgical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Zhi Ven Fong
- Division of Surgical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Raja R Narayan
- Division of Surgical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - S Jennifer Wang
- Division of Surgical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts; Drexel University, Philadelphia, Pennsylvania
| | - Jiping Wang
- Division of Surgical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
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Ivanov V, Dimov L, Strashilov S, Milkov D, Dzalov N, Chervenkov L. Robotic gastrointestinal stromal tumors surgery - initial results. Folia Med (Plovdiv) 2022; 64:884-888. [PMID: 36876566 DOI: 10.3897/folmed.64.e91448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/15/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) usually present as an exophytic mass localized in stomach. Years ago, conventional surgery was the only option. Laparoscopic and robotic procedures have risen to prominence in recent decades as technology and surgical techniques have advanced.
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Affiliation(s)
| | | | | | - Denis Milkov
- Medical University of Plovdiv, Plovdiv, Bulgaria
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Ceccarelli G, Costa G, De Rosa M, Codacci Pisanelli M, Frezza B, De Prizio M, Bravi I, Scacchi A, Gallo G, Amato B, Bugiantella W, Tacchi P, Bartoli A, Patriti A, Cappuccio M, Komici K, Mariani L, Avella P, Rocca A. Minimally Invasive Approach to Gastric GISTs: Analysis of a Multicenter Robotic and Laparoscopic Experience with Literature Review. Cancers (Basel) 2021; 13:cancers13174351. [PMID: 34503161 PMCID: PMC8431126 DOI: 10.3390/cancers13174351] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary Gastrointestinal stromal tumors (GISTs) represent about 1–3% of all gastrointestinal malignancies, of which 50–60% are gastric GISTs (GGs). To the date, surgery represents the best therapeutic option, and the robotic gastric surgery could gain an important role, overcoming many laparoscopic drawbacks. The aim of this study is to evaluate safety and effectiveness of minimally invasive surgery (MIS) for GGs, reporting 10-year experience of three different centers. We included a population of 81 patients who underwent MIS approaches (36 laparoscopy vs. 45 robotic surgery). Seventy-two (72) patients were enrolled in a follow-up program to evaluate the long-term oncological outcomes. Furthermore, we discussed some technical notes and also we analyzed the operative and peri-operative outcomes. In conclusion, our results suggest that the robotic approach might be a suitable treatment, especially for GISTs >5 cm, even located in unfavorable places, despite longer operative time and costs than laparoscopic approach. Abstract Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, 105 patients with a primary gastrointestinal stromal tumor (GISTs) located in the stomach, underwent surgery at three surgical units. (2) Results: A multi-institutional analysis of minimally invasive series including 81 cases (36 laparoscopic and 45 robotic) from 3 referral centers was performed. Males were 35 (43.2%), the average age was 66.64 years old. ASA score ≥3 was 6 (13.3%) in the RS and 4 (11.1%) in the LS and the average tumor size was 4.4 cm. Most of the procedures were wedge resections (N = 76; 93.8%) and the main operative time was 151 min in the RS and 97 min in the LS. Conversion was necessary in five cases (6.2%). (3) Conclusions: Minimal invasive approaches for gastric GISTs performed in selected patients and experienced centers are safe. A robotic approach represents a useful option, especially for GISTs that are more than 5 cm, even located in unfavorable places.
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Gianluca Costa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Surgery Center, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Michele De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, 06034 Perugia, Italy;
| | - Massimo Codacci Pisanelli
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery P. Valdoni, Policlinic Umberto I, Sapienza University of Study of Rome, 00161 Rome, Italy;
| | - Barbara Frezza
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Marco De Prizio
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Ilaria Bravi
- Histopathology Department, Usl Umbria 2, San Giovanni Battista Hospital, 06034 Foligno, Italy;
| | - Andrea Scacchi
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy;
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80126 Naples, Italy;
| | - Walter Bugiantella
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Piergiorgio Tacchi
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Bartoli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Patriti
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Division of General Surgery, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Klara Komici
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Lorenzo Mariani
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Aldo Rocca
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
- Correspondence:
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Di Maria Grimaldi S, Marano A, Pellegrino L, Geretto P, Palagi S, Borghi F. Robotic Wedge Resection for Unfavorably Located Gastric Gastrointestinal Stromal Tumors: Perioperative and Long-Term Oncological Outcomes. J Laparoendosc Adv Surg Tech A 2020; 31:772-778. [PMID: 33155875 DOI: 10.1089/lap.2020.0660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background and Objectives: Robotic wedge resection for gastrointestinal stromal tumors (GISTs) located in the stomach offers remarkable advantages, especially for lesions in unfavorable places. Although promising, long-term oncological results associated with this surgical procedure are poorly represented in literature. We present our experience of robotic wedge resection with gastrotomy for challenging gastric GISTs, in terms of both surgical outcomes and long-term oncological results. Methods: From April 2014 to February 2020, all consecutive patients affected by unfavorably located gastric GISTs (based on the Privette/Al-Thani classification system) underwent robotic wedge resection. Clinicopathological, surgical, and long-term oncological results were retrospectively analyzed. Results: Seventeen patients underwent full-thickness gastric wedge resection with primary robot-sewn closure of the defect. In 64.7% of cases, the lesion was ≥5 cm in diameter. No conversion nor tumor rupture were recorded and complete R0 resection was achieved in all cases. Median hospital stay was 5 days (range 3-18). At a median follow-up of 46 months (range 7-67), the disease-free survival rate and the overall survival rate were 94.1% and 82.3%, respectively. Conclusions: Robotic wedge resection with gastrotomy and robotic-sewn suture is a safe and feasible procedure for GISTs located in unfavorable anatomic positions, without compromising oncological outcomes.
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Affiliation(s)
- Simone Di Maria Grimaldi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Alessandra Marano
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Luca Pellegrino
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Paolo Geretto
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Silvia Palagi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Felice Borghi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
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7
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Solaini L, Cavaliere D, Fico V, Milone M, De Pascale S, Desiderio J, Vitali G, Parisi A, Fumagalli Romario U, De Palma GD, D'Ugo D, Ercolani G. Open versus laparoscopic versus robotic gastric gastrointestinal stromal tumour resections: A multicentre cohort study. Int J Med Robot 2020; 17:e2198. [PMID: 33131156 DOI: 10.1002/rcs.2198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE To present the outcomes of gastric gastrointestinal stromal tumour (GIST) resection from five Italian centres, focussing the analysis on the comparison among open (OG), laparoscopic (LG) and robotic (RG) approaches. METHODS All consecutive gastric wedge resections for GIST between 2009 and 2019 were included. RESULTS In total 101 (OG = 14, LG = 63 and RG = 24) were included. No differences were seen in the preoperative characteristics among the groups. Robotic procedures were longer (RG 180 min vs. LG 100 vs. OG 110; p < 0.0001). Time-to-first flatus and length of hospital stay were significantly longer in the OG group. Complication rates were similar among the groups. A sub-analysis on minimally invasive (RG = 19 vs. LG = 20) wedge resections and hand/robot-sewn suture showed that operative time was longer in the RGs (p = 0.007). No conversions were recorded in the RG group versus three in the LG group (p = 0.231). Safety-related factors were similar. CONCLUSIONS Gastric GIST can be safely treated with a minimally invasive approach which is also associated with improved postoperative outcomes.
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Affiliation(s)
- Leonardo Solaini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.,General and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Davide Cavaliere
- General and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Valeria Fico
- General Surgery Unit, Department of Surgery, "A. Gemelli" University Hospital, Catholic University of Rome, Rome, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Jacopo Desiderio
- Department of Digestive Surgery and Liver Unit, Santa Maria Hospital, Terni, Italy
| | - Giulia Vitali
- General and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Amilcare Parisi
- Department of Digestive Surgery and Liver Unit, Santa Maria Hospital, Terni, Italy
| | | | | | - Domenico D'Ugo
- General Surgery Unit, Department of Surgery, "A. Gemelli" University Hospital, Catholic University of Rome, Rome, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.,General and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
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8
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Winder A, Strauss DC, Jones RL, Benson C, Messiou C, Chaudry MA, Smith MJ. Robotic surgery for gastric gastrointestinal stromal tumors: A single center case series. J Surg Oncol 2020; 122:691-698. [PMID: 32488872 DOI: 10.1002/jso.26053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/06/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of surgical treatment of gastrointestinal stromal tumors (GIST) is a microscopically complete resection. Initial indications for laparoscopic surgery were limited to smaller tumors, in favorable locations. Over time, indications for minimal invasive surgery (MIS) have expanded, however concerns remain when considering resection of larger GISTs. Our aims were to assess the utility of robotic resection of gastric GISTs for challenging tumors. METHODS GIST resections, in this study were performed using the Intuitive Da Vinci Surgical Xi System. GIST's were considered challenging if tumor size was >50 mm at the time of surgery and/or the location of the tumor was type II, III, or IV using Privette/Al-Thanai classification. RESULTS Robotic resections were performed on 12 consecutive patients, 83% were considered challenging cases, 6 out of 12 for location and 5 out of 12 for size. Initial median tumor size on imaging was 53.7 mm, and post-imatinib was 45.8 mm. All tumors were removed with clear margins (R0) via wedge resections, with no complications. Median operative time was 192 minutes (95-250). Length of hospital stay was 2 days (2-6). CONCLUSIONS Robotic resection of gastric GIST's appears oncologically safe, and may expand the benefits of MIS to a greater cohort of complex cases.
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Affiliation(s)
- Alec Winder
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | - Dirk C Strauss
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | - Robin L Jones
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | - Charlotte Benson
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | | | - Mohammed Asif Chaudry
- Department of Oesophageal and Gastric Cancer Surgery, The Royal Marsden Hospital, London, UK
| | - Myles J Smith
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
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9
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Chernousov AF, Vetshev FP, Vychuzhanin DV, Khorobrykh TV, Egorov AV, Osminin SV, Gelmutdinova ER. [Laparoscopic and robot-assisted procedures in patients with gastrointestinal stromal tumors (GIST) of stomach]. Khirurgiia (Mosk) 2020:5-13. [PMID: 31994494 DOI: 10.17116/hirurgia20200115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To analyze the results of minimally invasive surgical procedures in patients with gastric GIST. MATERIAL AND METHODS The study included 30 patients aged 52.2±9.8 years. ASA grade II (44%), III (26%) and I (23%) were predominant. Lesion of stomach body was noted in 17 (56%) patients, antrum - in 8 (27%), fundus - in 2 (7%) and cardia - in 3 (10%) patients. GIST was located on the anterior wall of stomach in 56% of patients. Exophytic growth was observed in 16 (53%) patients, endophytic - in 12 (40%), transmural growth - in 2 (7%) cases. T2 grade of tumor was noted in 67% of cases (TNM 8). All patients underwent laparoscopic or robot-assisted ('daVinci Si') partial resection of the stomach. RESULTS Radical resection (R0) without injury of pseudocapsule of tumor was made in all patients. Laparoscopic procedures were performed in 25 (83%) patients, robot-assisted - in 5 (17%). Early postoperative complications (Clavien-Dindo II) were observed in 3 patients. Spindle cell structure of tumors (93%) with low mitotic activity (63%) prevailed. Tumor stage I was observed in 56% of patients. Patients with high mitotic tumor index (44%) were directed to targeted therapy. Recurrence and/or metastasis in long-term period were absent in 26 (87%) patients. CONCLUSION Laparoscopic surgery for gastric GIST is safe and characterized by the absence of significant postoperative complications and long-term recurrence-free period. The use of robotic surgical system is effective and justified for anatomically difficult localization of GIST.
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Affiliation(s)
- A F Chernousov
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - F P Vetshev
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - D V Vychuzhanin
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - T V Khorobrykh
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - A V Egorov
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - S V Osminin
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - E R Gelmutdinova
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
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10
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Maggioni C, Shida A, Mancini R, Ioni L, Pernazza G. Safety profile and oncological outcomes of gastric gastrointestinal stromal tumors (GISTs) robotic resection: Single center experience. Int J Med Robot 2019; 15:e2031. [DOI: 10.1002/rcs.2031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Cristina Maggioni
- Division of Robotic General SurgerySan Giovanni Addolorata Hospital Rome Italy
- School of Medicine and SurgeryUniversity of Florence Florence Italy
| | - Atsuo Shida
- Division of Robotic General SurgerySan Giovanni Addolorata Hospital Rome Italy
- Department of SurgeryThe Jikei University School of Medicine Tokyo Japan
| | - Raffaello Mancini
- Division of Robotic General SurgerySan Giovanni Addolorata Hospital Rome Italy
| | - Luigi Ioni
- Division of Robotic General SurgerySan Giovanni Addolorata Hospital Rome Italy
| | - Graziano Pernazza
- Division of Robotic General SurgerySan Giovanni Addolorata Hospital Rome Italy
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11
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Arseneaux M, Yarbrough D, Nagamoto T. Robotic-assisted free-handed, full-thickness gastric GIST resection with primary repair in unfavorable locations. J Robot Surg 2018; 13:491-494. [DOI: 10.1007/s11701-018-0876-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023]
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12
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Robotic Gastrotomy With Intracorporeal Suture for Patients With Gastric Gastrointestinal Stromal Tumors Located at Cardia and Subcardiac Region. Surg Laparosc Endosc Percutan Tech 2018; 28:e1-e7. [PMID: 29215507 PMCID: PMC5802256 DOI: 10.1097/sle.0000000000000498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Few studies of robotic gastric gastrointestinal stromal tumors (GISTs) resection have been conducted. This study was aimed to evaluate the robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region. MATERIALS AND METHODS From January 2014 to August 2016, 11 patients with GISTs located at cardia and subcardiac region underwent robotic gastrotomy with intracorporeal suture. Data of these patients were collected. RESULTS The mean operative time was 82.7 minutes and the mean blood loss was 30.0 mL. No complication was reported. The postoperative length of stay was 3.3 days. On postoperative day 14, inflammation recovered to preoperative level. On postoperative month 6, the nutritional status was similar to that before the surgery. After 25.5 months follow-up, all patients survived with no recurrence or metastasis. CONCLUSIONS Robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region is safe and feasible.
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13
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Furbetta N, Palmeri M, Guadagni S, Di Franco G, Gianardi D, Latteri S, Marciano E, Moglia A, Cuschieri A, Di Candio G, Mosca F, Morelli L. Gastrointestinal stromal tumours of stomach: Robot-assisted excision with the da Vinci Surgical System regardless of size and location site. J Minim Access Surg 2018; 15:142-147. [PMID: 29595183 PMCID: PMC6438064 DOI: 10.4103/jmas.jmas_260_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aims: The role of minimally invasive surgery of gastrointestinal stromal tumours (GISTs) of the stomach remains uncertain especially for large and/or difficult located tumours. We are hereby presenting a single-centre series of robot-assisted resections using the da Vinci Surgical System (Si or Xi). Subjects and Methods: Data of patients undergoing robot-assisted treatment of gastric GIST were retrieved from the prospectively collected institutional database and a retrospective analysis was performed. Patients were stratified according to size and location of the tumour. Difficult cases (DCs) were considered for size if tumour was >50 mm and/or for location if the tumour was Type II, III or IV sec. Privette/Al-Thani classification. Results: Between May 2010 and February 2017, 12 consecutive patients underwent robot-assisted treatment of GIST at our institution. DCs were 10/12 cases (83.3%), of which 6/10 (50%) for location, 2/10 (25%) for size and 2/10 (25%) for both. The da Vinci Si was used in 8 patients, of which 6 (75%) were DC, and the da Vinci Xi in 4, all of which (100%) were DC. In all patients, excision was by wedge resection. All lesions had microscopically negative resection margins. There was no conversion to open surgery, no tumour ruptures or spillage and no intraoperative complications. Conclusion: Our experience suggests a positive role of the robot da Vinci in getting gastric GIST removal with a conservative approach, regardless of size and location site. Comparative studies with a greater number of patients are necessary for a more robust assessment.
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Affiliation(s)
- Niccolo Furbetta
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | | | - Emanuele Marciano
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Andrea Moglia
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | | | - Giulio Di Candio
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa; EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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14
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Koh YX, Goh BKP. Minimally invasive surgery for gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol 2017; 2:108. [PMID: 29354765 DOI: 10.21037/tgh.2017.11.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/27/2017] [Indexed: 12/19/2022] Open
Abstract
Minimally invasive surgery has been increasingly performed for gastric gastrointestinal stromal tumors (GIST). In this review we discuss and summarize the current evidence on minimally invasive surgery for gastric GISTs. Laparoscopic resection for gastric GIST has been consistently shown to be associated with superior perioperative outcomes with no compromise in oncological outcomes when compared to open resection in numerous retrospective case-control studies. It has also been shown to be safe and feasible for large tumors or tumors located in unfavorable sites. However, to date, there remains a lack of level 1 evidence from prospective randomized control trials in support of laparoscopic resection.
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Affiliation(s)
- Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,Duke NUS Medical School, Singapore, Singapore
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15
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Robotic Versus Laparoscopic Gastric Resection for Primary Gastrointestinal Stromal Tumors >5 cm: A Size-Matched and Location-Matched Comparison. Surg Laparosc Endosc Percutan Tech 2017; 27:65-71. [PMID: 28079762 DOI: 10.1097/sle.0000000000000371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study compared robotic (RR) and laparoscopic resection (LR) for primary gastrointestinal stromal tumors (GISTs) of the stomach >5 cm. Twelve consecutive patients who underwent RR from 2012 to 2015 were matched for tumor size and location with 24 patients who underwent LR from 2000 to 2012. The median tumor size was 7.1 cm (range, 5.5 to 11.5). GISTs were resected by wedge resection (91.7%) or distal gastrectomy. The median RR operative time was longer than that of LR (162.5 vs. 130 min, respectively; P=0.004). Only 1 LR patient required conversion. The time to flatus and hospital stay were similar between groups. Overall, 3 patients developed minor postoperative complications that were medically treated. Mortality was nil. All resections were R0. No difference was observed in the incidence of recurrence. RR was significantly more expensive (+21.6%) than LR. RR appears to be safe and feasible for GISTs>5 cm, but is associated with longer operative times and greater costs.
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16
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Urgency surgical treatment for duodenal GISTs: analysis of aged patients and review of the literature. Aging Clin Exp Res 2017; 29:1-6. [PMID: 27844452 DOI: 10.1007/s40520-016-0641-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms (85%) of the gastrointestinal (GI) tract; duodenal GISTs constitute 3-5% of all GISTs and represent 10-30% of all malignant tumours of the duodenum. Rarely, patients present severe bowel obstruction, perforation or severe bleeding. The radical resection with complete removal of the tumour remains the main therapeutic approach. We performed a local resection in patients with suspected GIST admitted for emergency treatment for GI bleeding. CASES We present three cases of patients admitted for GI bleeding. The cause could be a GIST bleeding. In all cases, local resection was performed without a pancreaticoduodenectomy. Histological examination on surgical preparations showed that in two cases it was a GIST and in one case, it was a leiomyoma. DISCUSSION Surgery remains the treatment of choice in the case of a GIST primitive without evidence of metastases, even for patients who are hospitalized for a bleeding emergency. Wide resections are not needed; it is important to remove completely the disease. In the case of duodenal GIST, it is important to get negative margins near the head of the pancreas, and this could take a PD. According to our experience and to the literature review, we believe that if the duodenal papilla or the periampullary region is not interested, you must perform a local resection. This is also because non-malignant tumours may present as GISTs and in these cases it is not recommended to run a PD. CONCLUSION The treatment of choice for duodenal GISTs is complete surgical resection with negative resection margins. When the papilla or the periampullary region is involved we choose to perform pancreaticoduodenectomy; otherwise it is better to perform a local resection. In fact, local resection has lower morbidity and mortality, with a comparable outcome.
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17
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Al-Thani H, El-Menyar A, Mekkodathil A, Elgohary H, Tabeb AH. Robotic management of gastric stromal tumors (GIST): a single Middle Eastern center experience. Int J Med Robot 2016; 13. [PMID: 26813073 DOI: 10.1002/rcs.1729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/19/2015] [Accepted: 12/15/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Surgical resection is the gold standard treatment for gastrointestinal stromal tumors (GISTs). This paper describes the authors' experience in the management of posterior gastric wall GISTs through the robotic surgical approach. METHODS A case-series analysis for surgically resected GISTs was conducted between 2009 and 2010. All patients were followed up until mid-2015. RESULTS Robotic resection was performed in four cases. There was no evidence of bleeding or leak in all cases. The median hospital length of stay was 8 (5-8) days. No post-operative morbidity or mortality was reported during the follow-up duration (mean ± SD; 40.25 ± 35 months). CONCLUSION Findings show that the robotic assisted surgical approach to the removal of posterior wall gastric stromal tumors is associated with 100% disease-free survival rate. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.,Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Ahammed Mekkodathil
- Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Hesham Elgohary
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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18
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Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Malave L, Ferri V, Ferronetti A, Caruso R. Robot-assisted resection of gastrointestinal stromal tumors (GIST): a single center case series and literature review. Int J Med Robot 2015; 12:718-723. [PMID: 26549309 DOI: 10.1002/rcs.1712] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/15/2015] [Accepted: 10/05/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Robotic techniques are claimed to be an alternative to laparoscopic and open approaches for gastrointestinal stromal tumors (GIST) treatment. Our aim is to present our single center experience and a literature review. MATERIALS AND METHODS From June 2012 to August 2014, six patients with preoperative diagnosis of GIST were treated by robotic surgery at Sanchinarro University Hospital. RESULTS Two GIST tumors were localized in the second part of the duodenum, one in the first portion, two in the gastricantrum and another in the angular notch. Surgical procedures performed were two subtotal gastrectomies, one gastric wedge resection and three duodenal enucleations. None of the interventions needed conversion to open surgery. Mean operative time was 245 min (150-540). Mean hospital stay was 10.5 days (6-24). All lesions had microscopically negative resection margins. Mean follow-up was 24 months (8-33) with a disease-free survival rate of 100%. CONCLUSIONS A robotic approach for GIST tumors is a safe and feasible procedure with a well-accepted oncological surgical result. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Yolanda Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Benedetto Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Hipolito Duran
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Eduardo Diaz
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Isabel Fabra
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Luis Malave
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Valentina Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Antonio Ferronetti
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
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Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 2014; 29:253-88. [PMID: 25380708 DOI: 10.1007/s00464-014-3916-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/14/2022]
Abstract
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
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Affiliation(s)
- Amir Szold
- Technology Committee, EAES, Assia Medical Group, P.O. Box 58048, Tel Aviv, 61580, Israel,
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Al-Thani H, El-Menyar A, Rasul KI, Al-Sulaiti M, El-Mabrok J, Hajaji K, Elgohary H, Tabeb A. Clinical presentation, management and outcomes of gastrointestinal stromal tumors. Int J Surg 2014; 12:1127-33. [PMID: 25152441 DOI: 10.1016/j.ijsu.2014.08.351] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/23/2014] [Accepted: 08/10/2014] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The present study investigated the incidence, management and outcome of Gastrointestinal Stromal Tumors (GIST) in Qatar. METHODS A retrospective review of all GIST patients admitted between 1995 and 2012 was conducted. Patients' demographics, clinical presentation, tumor characteristics, radiological, pathological and immunohistochemical findings, surgical procedures, recurrence and mortality were recorded. RESULTS A total of 48 GIST patients were identified. Stomach (56%) and small intestine (27%) were the most common sites of tumor. The majority of cases (n = 27) had tumor size >5 cm, 31 cases had primary and 15 cases had locally advanced tumor. Patients were stratified as high, intermediate, and low risk (43.8%, 18.8% and 37.5%, respectively). Almost all the cases were surgically managed and 94% were completely resectable. Robotic partial resection was performed in 4 cases and 5 cases underwent laparoscopic resection. Chemotherapy was initiated in half of patients. During follow up (average 37.5 months), 33 patients showed complete recovery, 7 had recurrent or metastatic disease and 2 died due to liver metastasis. CONCLUSION The incidence of GIST in Qatar is apparently low. Surgical resection is the preferred choice of treatment; however, robotic and laparoscopic resections are feasible and safe approaches in some cases.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | | | | | | | - Khairi Hajaji
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hesham Elgohary
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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