Abstract

Background: Minimally invasive surgical techniques have become increasingly integrated into the management of upper gastrointestinal malignancies, particularly pancreatic and gastric cancers. Robotic surgery represents an evolution of minimally invasive surgery, providing three-dimensional visualization, tremor filtration, and enhanced instrument articulation. Comparative studies suggest that robotic surgery may reduce intraoperative blood loss and improve perioperative recovery while maintaining oncologic adequacy [1–3].

Objective: This systematic review evaluates recent advancements in minimally invasive surgery for upper gastrointestinal malignancies by comparing robotic and open surgical approaches in pancreatic and gastric cancer resections, focusing on oncologic outcomes, lymph node dissection quality, and perioperative safety.

Methods: A systematic literature review was conducted following PRISMA guidelines. Peer-reviewed studies published between 2020 and 2022 were identified through database searches including PubMed and Scopus. Eligible studies included systematic reviews, meta-analyses, and comparative cohort studies evaluating robotic and open pancreatic and gastric surgery. Outcomes assessed included operative time, intraoperative blood loss, lymph node yield, R0 resection rates, postoperative morbidity, and hospital stay.

Results: Robotic surgical approaches demonstrated oncologic outcomes comparable to open surgery in both pancreatic and gastric cancer procedures. Meta-analysis data indicate that robotic surgery reduces intraoperative blood loss by approximately 150–200 mL compared with open procedures (p < 0.05) [1]. Lymph node retrieval remained comparable, with robotic gastrectomy achieving median lymph node counts of 25–35 nodes, consistent with D2 lymphadenectomy standards [3]. Robotic approaches were also associated with shorter hospital stay, typically reduced by 2–4 days, and lower postoperative complication rates in selected patient populations [4]. Robotic pancreaticoduodenectomy demonstrated acceptable safety profiles in high-volume centers despite longer operative time during the early learning phase [5].

Conclusion: Robotic surgery represents a safe and effective minimally invasive alternative to open surgery for selected patients with upper gastrointestinal cancers. Although oncologic outcomes appear comparable, the advantages of reduced blood loss, faster recovery, and improved surgical precision support the growing role of robotic platforms in gastrointestinal oncology. Further randomized studies are required to validate long-term survival outcomes.

Keywords: Minimally invasive surgery; Robotic surgery; Open surgery; Upper gastrointestinal cancer; Pancreatic cancer; Gastric cancer.