Several meta-analyses have tried to define the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary.
Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarification. However, despite the increasing interest, the difficulty of planning studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences.
A multi-institutional study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses.
Data analysis with high methodological quality on minimally invasive and open gastrectomies can clarify the role of different procedures with the aim to develop specific guidelines.
Significant limitations, in this field, are found from an analysis of studies published in the current literature, including:
- Small samples of patients, mostly low-quality comparative studies
- Selection bias in the comparison groups (e.g. stage, extent of lymphadenectomy)
- Absence of subgroup analysis in significant research fields
- Lack of information on the surgical techniques adopted
A large multicenter analysis could thus be the optimal way to clarify the role of minimally invasive surgery for gastric cancer and permit the evaluation of its short and long-term effects. A working basis for analyzing outcomes of interest and obtaining directions for guidelines and future study developments can also be created. The following would be the main advantages of a data analysis from a large multicenter data collection:
-Achieving a large sample of patients
-Collecting multiple variables, allowing for the making of a comprehensive statistical report
-Standardizing the methodology to be adopted, thus increasing accuracy
-Bringing together the experiences of both East and West to discover shared points
This analysis can guide research in this field to new developments and pave the way for other investigational opportunities.