title: Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits.
abstract: BACKGROUND
  Gastric cancer represents a great challenge for health care providers and requires a multidisciplinary approach in which surgery plays the main role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and more recently with the spread of robotic surgery, but a number of issues are currently being investigate, including the limitations in performing effective extended lymph node dissections and, in this context, the real advantages of using robotic systems, the possible role for advanced Gastric Cancer, the reproducibility of completely intracorporeal techniques and the oncological results achievable during follow-up.
  
  
  METHODS
  Searches of MEDLINE, Embase and Cochrane Central Register of Controlled Trials were performed to identify articles published until April 2014 which reported outcomes of surgical treatment for gastric cancer and that used minimally invasive surgical technology. Articles that deal with endoscopic technology were excluded.
  
  
  RESULTS
  A total of 362 articles were evaluated. After the review process, data in 115 articles were analyzed.
  
  
  CONCLUSIONS
  A multicenter study with a large number of patients is now needed to further investigate the safety and efficacy as well as long-term outcomes of robotic surgery, traditional laparoscopy and the open approach.
authors.affiliation: Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy.
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
authors.affiliation: Department of Surgery, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center, Orange, CA, USA.
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.affiliation: Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reim
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School, Nanjing University, Nanjing, PR China.
authors.forename: Shu
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School, Nanjing University, Nanjing, PR China.
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Jiang
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel Medical Center, New York, NY, USA.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Brower
authors.affiliation: Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE), Centre Hospitalier de Luxembourg, Luxembourg.
authors.forename: Juan-Santiago
authors.initials: JS
authors.lastname: Azagra
authors.affiliation: Service de chirurgie digestive et cancérologique CHU Bocage, Dijon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Facy
authors.affiliation: Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Alimoglu
authors.affiliation: Division of General Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Jackson
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsujimoto
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.affiliation: Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, PR China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zang
authors.affiliation: Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
authors.affiliation: Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, PR China.
authors.forename: Pei-Wu
authors.initials: PW
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, PR China.
authors.forename: Ben
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, PR China.
authors.forename: Feng
authors.initials: F
authors.lastname: Qi
authors.affiliation: Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Coratti
authors.affiliation: Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Annecchiarico
authors.affiliation: Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Novotny
authors.affiliation: Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE), Centre Hospitalier de Luxembourg, Luxembourg.
authors.forename: Martine
authors.initials: M
authors.lastname: Goergen
authors.affiliation: Service de chirurgie digestive et cancérologique CHU Bocage, Dijon, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lequeu
authors.affiliation: Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Tunc
authors.initials: T
authors.lastname: Eren
authors.affiliation: Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Leblebici
authors.affiliation: Division of Surgical Oncology, Medstar Georgetown University Hospital, Washington DC, USA.
authors.forename: Waddah
authors.initials: W
authors.lastname: Al-Refaie
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.affiliation: Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, PR China.
authors.forename: Junjun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, PR China.
authors.forename: Yong-Liang
authors.initials: YL
authors.lastname: Zhao
authors.affiliation: Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, PR China.
authors.forename: Tong
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy. Electronic address: djdesi85@hotmail.it.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
mesh_terms: D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Gastrectomy; Gastric cancer; Laparoscopic surgery; Minimally invasive surgery; Robotic surgery