Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer

Abstract

Objective: To evaluate the short-term outcomes of patients with GC who received RDG or LDG. Summary Background Data: Despite the increasing use of RDG in patients with GC, its safety and efficacy compared to those of LDG have not been elucidated in a randomized controlled trial. Methods: Three hundred patients with cT1-4a and N0/+ between September 2017 and January 2020 were enrolled in this randomized controlled trial at a high-volume hospital in China. The short-term outcomes were compared between the groups. Results: The modified intention-to-treat analysis included data from 283 patients (RDG group: n = 141) and (LDG group: n = 142). Patients in the RDG group exhibited faster postoperative recovery, milder inflammatory responses, and reduced postoperative morbidity (9.2% vs 17.6%, respectively, P = 0.039). Higher extraperigastric lymph nodes (LNs) were retrieved in the RDG group (17.6 ± 5.8 vs 15.8 ± 6.6, P = 0.018) with lower noncompliance rate (7.7% vs 16.9%, respectively, P = 0.006). Additionally, patients in the RDG group were more likely to initiate adjuvant chemotherapy earlier [median (interquartile range) postoperative days: 28 (24–32) vs 32 (26–42), P = 0.003]. Although total hospital costs were higher in the robotic group than in the laparoscopic group, the direct cost was lower for RDG than for LDG (all P < 0.001). Conclusions: RDG is associated with a lower morbidity rate, faster recovery, milder inflammatory responses, and improved lymphadenectomy. Additionally, faster postoperative recovery in the RDG group enables early initiation of adjuvant chemotherapy. Our results provide evidence for the application of RDG in patients with GC.

Comparison of short-term outcomes and quality of life in totally laparoscopic distal gastrectomy and totally robotic distal gastrectomy for clinical stage I–III gastric cancer: study protocol for a multi-institutional randomised clinical trial

“…For RDG, Lu’s RCT study showed that patients in the RDG group reduced postoperative morbidity compared with LDG group (9.2% vs 17.6%, p=0.039). 12 As the incidence rates in the TRDG group range from 4.7% to 15.9% in retrospective studies 16 31 32 and given the proficiency of surgeons who perform robotic gastrectomy and the reasonable cost-effectiveness of robotic surgery, 9.0% is the expected 30-day postoperative morbidity in the TRDG group in this study. PASS V.15.0 software was used to calculate sample sizes of 307 with a 1:1 ratio in each group, achieving 80% power to detect a difference between the group proportions of 7.5%.…”

“…[8][9][10][11] Recently, Lu's RCT study demonstrated that RDG had lower postoperative complication rate compared with LDG for clinical stage I-III patients. 12 These results indicate the potential superiority of RDG. However, the currently available evidence on robotic gastrectomy is still limited, which need more evidence-based studies to explore the effect of RDG.…”

Comparison of Short-term Surgical Outcomes Using Da Vinci S, Si and Xi Surgical System for Robotic Gastric Cancer Surgery

“…Robotic gastrectomy (RG) for gastric cancer (GC) was introduced speci cally to overcome the kinematic restrictions of conventional laparoscopic gastrectomy (LG), including the limited range of movement, ampli cation of operator hand tremors, and inconvenient surgical positioning. We and others have suggested that robotic approach for GC led to a reduction of the incidence of postoperative complications, resulting in improved safety and effective surgical results compared with LG [1][2][3][4] . The total operation time, however, has been reported in several studies to be longer by RG than by LG [4][5][6][7] .…”

“…We and others have suggested that robotic approach for GC led to a reduction of the incidence of postoperative complications, resulting in improved safety and effective surgical results compared with LG [1][2][3][4] . The total operation time, however, has been reported in several studies to be longer by RG than by LG [4][5][6][7] . These longer operation times might be attributed to the setting and docking of the robotic arms.…”

Textbook outcome and survival of robotic versus laparoscopic total gastrectomy for gastric cancer: A propensity score matched cohort study

“…Recently, robotic gastrectomy showed reliable surgical outcomes as an alternative for laparoscopic gastrectomy in minimally invasive surgery for the treatment of gastric cancer [14][15][16][17][18][19]. However, these studies focused on singlequality indicators such as bleeding, retrieved lymph nodes, complications, and mortality to compare short-term outcomes.…”