[Current Status and Future Prospect of Robotic Gastrectomy for Gastric Cancer].

ABSTRACT

Robotic gastrectomy had been firstly performed in Japan. The first case series in Japan had been reported by Prof. Uyama of Fujita Medical University in 2011, at which time the double bipolar method, the current standard procedure in Japan, had already been established. Subsequently, a prospective cohort study using laparoscopic gastrectomy as a historical control was conducted under advanced medical care to establish evidence of robotic gastrectomy. As a result, robotic gastrectomy was proven to be safer than laparoscopic gastrectomy, and was approved by health insurance. Furthermore, a survival analysis has showed that overall survival was significantly better in robotic gastrectomy than in laparoscopic gastrectomy, and additional cost for robotic surgery has been covered by insurance. The guidelines of the Japanese Gastric Cancer Association and the Japanese Society for Endoscopic Surgery weakly recommend the use of robotic surgery for cStage Ⅰ or cStage Ⅰ/Ⅱgastric cancer. In order to establish more solid evidence for robotic gastrectomy randomized controlled trials are currently being conducted. Future issues will be the establishment of evidence for robotic surgery and the safe introduction of new robots. Revision of facility standard should also be needed since the number of gastrectomy has been dramatically decreased in Japan.