Robot-Assisted Oncologic Resection for Large Gastric Gastrointestinal Stromal Tumor: A Preliminary Case Series

Background: Laparoscopic resection of gastric gastrointestinal stromal tumor (GIST) has been shown as feasible and safe in terms of oncologic results. However, laparoscopic resection has been demonstrated to be mainly suitable for small, favorably localized GIST. The robotic approach may, by its characteristics, enable the surgeon to perform atypical gastrectomies in an unfavorable location (i.e., close to pylorus or cardia). Its use in oncologic gastric surgery has been poorly defined and has never been reported for GIST. Materials and Methods: All patients who underwent robotic-assisted gastric resection for GIST at a single institution from 2006 to 2009 were prospectively followed-up. Results: There were 5 patients (3 men and 2 women), with a median age of 39 years (range, 32-74), who had a complete resection (R0). Two patients had a cardial GIST and 3 of the antrum. Median tumor sizes were of 5.5 cm (range, 4.2-7). According to Fletcher criteria, 4 tumors (80%) were classified as intermediate or high risk. No postoperative morbidity and mortality were noted. One patient had a conversion to open surgery because of a suspicion of diffuse adenocarcinoma on fresh frozen section and necessitated a total gastrectomy with a radical lymph node dissection. Median operation time was 192 minutes (range, 132-285). With a median follow-up of 18 months (range, 11-27), disease-free survival rate was 100%. Conclusions: The da Vinci (R) robot (Intuitive Surgical, Inc., Sunnyvale, CA) is a valuable instrument for oncologically safe resection with esogastric or duodenogastric junction preservation for an unfavorably located gastric GIST. Moreover, the three-dimensional, high-definition vision, instrument mobility, and ease of performing a difficult suturing enable a safe, large atypical gastrectomy, close to the pylorus or cardia.