title: Robot-assisted gastrectomy and oesophagectomy for cancer.
abstract: BACKGROUND
  Robot-assisted surgery is a technically feasible alternative to open and laparoscopic surgery, which is being more frequently used in general surgery. We undertook this review to investigate whether robotic assistance provides a significant benefit for oesophagogastric cancer surgery.
  
  
  METHODS
  Electronic databases were searched for original English-language publications for robotic-assisted gastrectomy and oesophagectomy between January 1990 and October 2013.
  
  
  RESULTS
  Sixty-one publications were included. Thirty-five included gastrectomy, 31 included oesophagectomy and five included both operations. Several publications suggest that robot-assisted subtotal gastrectomy can be as safe and effective as an open or laparoscopic procedure, with equal outcomes with regard to the number of lymph nodes resected, overall morbidity and perioperative mortality, and length of hospital stay. Robotic assistance is associated with longer operation times but also with less blood loss in some reports. A significant benefit for robotic assistance has not been shown for the more extensive operations of oesophagectomy or total gastrectomy with D2-lymphadenectomy. There are very few oncologic data regarding local recurrence or long-term survival for any of the robotic operations.
  
  
  CONCLUSIONS
  No significant differences in morbidity, mortality or number of lymph node harvested have been shown between robot-assisted and laparoscopic gastrectomy or oesophagectomy. Robotic surgery, with its relatively short learning curve, may facilitate reproducible minimally invasive surgery in this field but operation times are reportedly longer and cost differences remain unclear. Randomized trials with oncologic outcomes and cost comparisons are needed.
authors.affiliation: Department of Surgery, St. Vincent's Hospital and University of Notre Dame School of Medicine, Sydney, New South Wales, Australia; Department of Surgery, Lund University and Lund University Hospital (Skane University Hospital), Lund, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Falkenback
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Lehane
authors.forename: Reginald V N
authors.initials: RV
authors.lastname: Lord
mesh_terms: D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D012371:Robotics; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: gastrectomy; minimally invasive surgery; oesophagectomy; robot; robot-assisted surgery; robotic surgery