Technical aspects, short- and long-term outcomes of laparoscopic and robotic D2-lymphadectomy in gastric cancer

Purpose: Gastric cancer is a common malignancy and its radical excision with an adequate lymph node resection provides an improved oncologic outcome. D2 lymphadenectomy in distal or total gastrectomy is considered a highly desirable technique for curable early or locally advanced gastric cancer. Many studies with high-level of evidence confirm the importance of the application of minimally invasive techniques in improving the short-and long-term outcomes of patients who undergo gastrectomy. Methods: A MEDLINE search was performed with the following keywords; "d2 gastrectomy open laparoscopic", "d2 gastrectomy open robotic" and "d2 gastrectomy laparoscopic robotic". The search was narrowed on randomized control trials (RCT). Results: 6 studies in total are included in the present study; 5 RCTs on open vs laparoscopic group and 1 RCT on open vs robotic group. There is currently no RCT comparing the laparoscopic vs robotic techniques. Conclusions: The superiority of laparoscopic gastrectomy towards the open technique is widely accepted, yet the proven acceptance of minimally invasive robotic techniques is still debated and not scientifically established. Technical challenges are the main point of discussion among the experts on the field, as well as the advantages of laparoscopic and robotic-assisted gastrectomy over the conventional open. This review provides a comparison on technical aspects, the short-and long-term outcomes of open and minimally invasive gastrectomy with D2 lymphadenectomy in early and advanced gastric cancer.