Despite new multimodal therapeutic treatments with improved survival, surgery remains the only cure for gastric cancer. The gold standard in surgical treatment for locoregionally advanced resectable gastric cancer is either open total gastrectomy or open distal gastrectomy with radical D2 lymphadenectomy. Minimally invasive gastrectomy has been shown to be beneficial in Japanese and Korean studies in terms of postoperative clinical outcomes while maintaining oncological standards in terms of extensive lymph node harvest and survival. While the shift to minimally invasive laparoscopic and robotic gastrectomy for stages T1-T3 in Asia has already been accomplished, lower incidences, more advanced stages, and higher BMIs have led to slower adoption in Western countries. The quality of the systematic D2 lymphadenectomy is essential for proper staging and for oncologic outcomes.

Our academic work in gastric cancer focused on the lymphatic drainage pattern and visualization of draining lymph nodes and stations in gastric cancer. In collaboration with Professor Hyung and his team at Yonsei University in Seoul, South Korea, we investigated the feasibility of visualization and lymphography-guided lymphadenectomy by peritumoral injection of indocyanine green. The aim was to assess the sensibility of such a tracer to detect all metastatic stations and metastatic lymph nodes in locoregionally advanced gastric cancer.

Bariatric metabolic surgery for obese patients has proven to be beneficial in durable weight loss and effective in resolution of metabolic comorbidites. Among the underestimated metabolic comorbidites are nonalcoholic fatty liver and nonalcoholic steatohepatitis, which afflict up to 90% of obese patients. We investigated whether patients with nonalcoholic steatohepatitis would benefit equally from bariatric surgery compared to patients with simple steatosis.

Meanwhile, rising obesity is leading to technical challenges during surgery, and patients with associated comorbidities can be at increased risk of severe postoperative complications. Striving to standarize Roux-en-Y gastric bypass and to minimize the risk of postoperative complications, particularly leak rates, we started to investigate the robotic approach for this procedure in 2006. We found the robotic approach to be beneficial in terms of postoperative outcomes, particularly leak rates and conversions, and compared our results with the current literature.