How Robotic-assisted Stomach and Esophageal Cancer Surgery Can Improve Recovery.

The esophagus and stomach constitute the upper part of the gastro-intestinal tract. Cancers in this region can be quite challenging to treat and often involve a multi-disciplinary team with experience in the treatment of these complex tumors.  

To remove cancerous tissues successfully, surgeons must navigate near major blood vessels and in tight spaces, such as where the stomach meets the esophagus. Robotic-assisted surgery offers us the most precise treatment approach and our patients the best chance at a rapid recovery.

Distal stomach cancer develops in the lower part of the stomach, and rates in the U.S. have been falling. This is likely due to safer food storage (like refrigeration versus salting and smoking) and a decline in infections of H. pylori, a bacterium thought to cause stomach cancer. 

However, the incidence of cancers in the upper part of the stomach and the gastroesophageal junction have been increasing. This is likely due to obesity, chronic gastroesophageal reflux (GERD), smoking, and a diet high in processed foods.  

The American Cancer Society (ACS) estimates that about 31,510 people will be diagnosed with stomach cancer this year, and about 10,740 people will die of the disease. ACS estimates indicate more than 22,500 people will be diagnosed with esophageal cancer in 2026 and more than 16,000 people will die of the disease. 

Cancers of the stomach and esophagus require an experienced surgical approach. The majority of patients will receive neoadjuvant chemotherapy prior to surgery, but some patients with early-stage cancer may benefit from surgery upfront. When planning treatment with my patients, we discuss the benefits and drawbacks to decide together which surgery can help best meet their goals.

As System Chief of Surgical Oncology for MedStar Health, I’ve seen how robotic-assisted surgery offers a fundamental shift in treatment. This high-tech approach offers patients a less invasive, precise surgery with a faster recovery, less risk of postoperative complications such as hernias, less pain, more rapid return to normal activities and allows them to resume chemotherapy sooner.  

What is robotic-assisted surgery?

Gastrectomy is surgery to remove all or part of the stomach. Esophagectomy is surgery to remove the distal part of the esophagus and the proximal part of the stomach. Traditionally, surgeons remove cancerous tissues and nearby lymph nodes through a large incision in the upper abdomen. With the assistance of modern technologies, we’re now able to do better. 

The da Vinci® Surgical System is a robotic assistant that the surgeon controls. During the procedure, the surgeon sits a few feet from the patient in the operating room. They look through a viewfinder that shows a 3D view of the patient’s anatomy while the surgeon’s hands control small instruments on robotic arms.

The process begins with a few small incisions in the skin about the size of a fingertip. We insert miniature instruments and a tiny camera through these openings. The console translates our movements to the robotic arms in real-time with incredible steadiness and precision. This remarkable technology can significantly improve both the surgery and outcomes for our patients. 

Related: Read: "How a Healthier Lifestyle Can Help Reduce Your Risk of Stomach Cancer."

Better visualization and more precision.

In the abdomen, the robotic system provides a 3D, high-definition, magnified view of each patient’s unique anatomy. This provides the surgeon a clearer view than would have been possible with traditional surgery. The robot also uses advanced technology that enables instruments to rotate and bend with a much greater range of motion than the human wrist.

This instrumentation is critical during robotic gastrectomy, when we usually perform an advanced technique known as lymph node dissection. Facilitated by the robotic assistant, we carefully remove the lymph nodes around the stomach, esophagus, and major blood vessels. 

Greater range of motion helps us ensure all the cancer has been removed. It also helps us reduce the risk of complications that can arise from bigger incisions, particularly in patients who have larger abdominal walls. 

Stronger, faster healing after surgery.

Robotic-assisted surgery offers patients demonstrated clinical improvements, which include:
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• Less risk of blood loss and infection: With tiny incisions, there’s less bleeding and fewer opportunities for infection

• Less pain: More precise surgery with smaller instruments makes for easier healing

• Reduced risk of complications: Using a special incision called a “Pfannenstiel incision” (sometimes called a “bikini cut”) allows us to remove the cancerous organ while minimizing the risk of complications such as hernia and wound challenges that can lead to rehospitalization

• Shorter hospital stays: Most patients go home in 1-2 days, while patients who have open surgery often remain in the hospital for 3-4 days

• Quicker return to function: With less internal trauma, patients can walk sooner, their bowels resume normal function faster, and they usually require much less pain medication

The most exciting benefit relates to patients’ long-term treatment. Most people who have stomach cancer need chemotherapy before and after surgery to make sure all the cancer is treated. After open surgery, it can take six weeks to recover well enough to begin this adjuvant chemotherapy. 

With the robotic-assisted approach, chemo can begin just two to three weeks after surgery. Getting back to treatment sooner can help eliminate remaining microscopic cancer cells before they have a chance to grow. 

A high-volume team with a 14-day goal.

When it comes to cancer, earlier is better. The sooner we can spot cancer and remove it, the more likely we can help patients achieve good outcomes. That’s why we have a 14-day goal. From the moment of diagnosis, our teams work to have a personalized treatment plan finalized within just two weeks.

Every week, we gather expert surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists, radiologists, and pathologists to review the details of each individual patient. Together, this tumor board considers factors such as the DNA fingerprint (the molecular profile) of each patient’s the tumor to determine if newer treatments such as immunotherapy or enrollment in a clinical trial can help.

With a complicated condition such as stomach cancer or esophageal cancer, it’s a good idea to see a team at a high-volume center like ours. We perform these surgeries regularly. Just like an athlete who practices every day, repetition means we’re well equipped to handle the nuances of each patient’s unique circumstances.

Cancer is a complex disease, but you don’t have to navigate it alone. With a team-based approach and the most advanced robotic-assisted surgical technology, we’re making what used to be a daunting diagnosis more routine, improving recovery and helping more patients move beyond stomach and esophageal cancer.