Early experience with total robotic D2 gastrectomy in a low incidence region: surgical perspectives

BACKGROUND: Few European centers have reported on robotic gastrectomy for malignancy. We report our early experience with curative-intent total robotic gastrectomy. MATERIALS AND METHODS: The Intuitive Surgery Da Vinci Surgical System Xi 4 armed robot was used. Routine D2 lymphadenectomy was applied. RESULTS: Some 27 patients with adenocarcinoma (n = 18), hereditary cancer susceptibility (n = 8) and premalignancy (n = 1) were allocated to robotic gastrectomy, three were excluded due to inoperability during surgery. Median (range) age was 66 (18–87) years, 14 (58.3%) were females and body mass index was 25.5 (22.1–33.5) kg/m(2). Total gastrectomy was performed in 19 (79.2%) and subtotal in five (20.8%) patients. One (4.2%) procedure was converted to laparotomy. Procedural time was 273 (195–427) minutes. Three (12.5%) patients were reoperated within 30 days, one (4.2%) died. Serious complications (Clavien Dindo IIIb or more) occurred in three (12.5%) patients. Postoperative hospital stay was 10 (6–43) days. Fourteen of 16 (87.5%) patients with adenocarcinoma/premalignancy received radical resections. The median number of harvested lymph nodes was 20 (11–34). Eleven (73.3%) patients with adenocarcinoma had T3/T4 tumors and 6 (40%) had TNM stage III or more. CONCLUSION: Total robotic D2 gastrectomy appears feasible and safe during early introduction in a low incidence region.