Open versus laparoscopic versus robotic gastrectomy for cancer: need for comparative-effectiveness quality

摘要: New technologies and medical devices may improve both health care research toward the development of new drugs. But they are a major driver increases in U.S. expenditures, which have grown by an estimated 71% since 2000 [1]. In economic crisis, cost effectiveness for therapies (e.g., robotic surgery) should be considered. The market drugs is regulated Food Drug Administration (FDA), scrutinizes clinical trial data evidence safety efficacy. Although FDA has been criticized missteps inefficiencies its approval process, more relevant oversight labeling promotion products. Indeed, does not require inclusion statements regarding product’s comparative effectiveness. Clinicians, patients, payers would less willing to pay treatment such as surgery without proof that it improves outcomes. Comparative-effectiveness current standard strategy drawing robust conclusions about drugs, devices, surgical techniques [2]. Randomized phase 3 trials best tools ultimate decisions medicine. resectable gastric cancer includes gastrectomy adjuvant chemotherapy with or radiotherapy [3–5]. It thought quality [6] including standardized D2 lymphadenectomy can survival patients stage 2 disease [7–12]. improving patient outcomes include endoscopic submucosal resection early cancer, laparoscopic gastrectomy, surgery. All these treatments provide their superiority over open before widely used. Oncologic principal priority patients. minimally invasive life (QOL), ensured do increase recurrence risk mortality. recent issue Surgical Endoscopy, Kim et al. [13] provided comparison-effectiveness information versus cancer. authors compared results using da Vinci system those 11 12 gastrectomies performed during same period (31 December 2007 30 June 2008). At baseline, no significant difference clinicopathologic characteristics tumor was observed between three groups. total number lymph nodes retrieved (TNODS) used control measure gastric, colorectal, other cancers, did differ significantly among Robotic associated blood loss shorter postoperative hospital stay. morbidity similar No conversion group. colleagues concluded experienced surgeons safely perform short-term This study provides encouraging on use small retrospective long-term G. Glantzounis D. Ziogas (&) Baltogiannis University Ioannina, Greece e-mail: deziogas@hotmail.com