International Journal of Clinical Case Reports 2024, Vol.14, No.4, 221-229 http://medscipublisher.com/index.php/ijccr 224 higher costs. Additionally, robotic systems are not widely available, limiting their accessibility to certain regions and hospitals (Parisi et al., 2015). Surgeons also face challenges in performing intracorporeal anastomoses, which require high levels of technical skill (Lee et al., 2015). 4.2 Complications and postoperative morbidity: case studies Despite the benefits of minimally invasive techniques, complications such as anastomotic leaks, bleeding, and infections can occur. Studies have shown that while laparoscopic surgeries lead to fewer immediate postoperative complications compared to open surgeries, there are cases where morbidity rates remain similar, particularly in advanced-stage cancers. Robotic surgeries, though reducing blood loss and pain, have not consistently demonstrated lower complication rates compared to laparoscopic procedures in real-world applications (Greenleaf et al., 2017). 4.3 Limitations of minimally invasive surgery in advanced gastric cancer The application of minimally invasive surgery (MIS) in advanced gastric cancer remains controversial. While feasible in early gastric cancer, MIS for advanced stages poses challenges in terms of ensuring adequate lymph node dissection and achieving oncologic safety. Extended lymphadenectomy, which is crucial for advanced cancers, is technically more difficult using MIS due to limited access and visualization. Moreover, there is insufficient evidence to confirm that MIS offers long-term survival benefits in advanced-stage cases, as highlighted by ongoing clinical trials (Desiderio et al., 2015). 4.4 Addressing skill gaps in surgeons: training and certification A key limitation of adopting advanced surgical techniques like robotic and laparoscopic gastrectomies is the skill gap among surgeons. MIS requires specialized training, including learning to operate advanced robotic systems, which are not universally available. Certification programs and hands-on workshops are essential for equipping surgeons with the necessary skills to perform these complex procedures safely and effectively. However, the learning curve for these techniques remains steep, and it is crucial to develop more standardized training and certification pathways to ensure competency across regions (Cassidy et al., 2017). 5 Role of Multidisciplinary Teams in Gastric Cancer Surgery 5.1 Importance of preoperative assessment and collaboration Preoperative assessment plays a critical role in optimizing outcomes for gastric cancer surgery, and the involvement of multidisciplinary teams (MDTs) is vital in this process. MDTs enable comprehensive evaluations that include surgeons, oncologists, radiologists, and other specialists, ensuring that all aspects of the patient’s condition are considered. Through coordinated preoperative discussions, the team can assess the tumor stage, evaluate the patient's overall health, and decide the best surgical approach or the need for neoadjuvant treatments such as chemotherapy or radiotherapy. Studies have shown that MDTs help improve diagnostic accuracy and treatment planning, reducing the likelihood of unnecessary or delayed interventions (Boniface et al., 2016). 5.2 Integration of surgeons, oncologists, and radiologists for optimal outcomes The integration of multiple specialties in the treatment of gastric cancer is essential to achieving optimal patient outcomes. Collaboration among surgeons, medical oncologists, and radiologists allows for better decision-making, particularly when considering complex cases. By combining expertise, these teams ensure that patients receive personalized treatment plans tailored to their specific conditions. Evidence shows that multidisciplinary teams are associated with better survival outcomes, especially when decisions are made collectively regarding the extent of surgery, the use of adjuvant therapies, and the timing of interventions (Xiang et al., 2022). 5.3 Case studies highlighting the success of multidisciplinary approaches Several case studies have demonstrated the effectiveness of MDTs in managing complex gastric cancer cases. For example, a retrospective study at Parkland Hospital (Dallas, TX) showed that the implementation of an MDT reduced the time to treatment from an average of 84.1 days to 32.5 days, highlighting the efficiency of parallel evaluation and decision-making across specialties. The study also found a significant reduction in unnecessary
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