Comparison of Long-Term and Perioperative Outcomes of Robotic Versus Conventional Laparoscopic Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis of PSM and RCT Studies

Abstract

BackgroundTo investigate the perioperative and oncological outcomes of gastric cancer (GC) after robotic versus laparoscopic gastrectomy (RG versus LG), we carried out a meta-analysis of propensity score matching (PSM) studies and randomized controlled study (RCT) to compare the safety and overall effect of RG to LG for patients with GC.MethodsPubMed, Web of Science, EMBASE, and Cochrane Central Register were searched based on a defined search strategy to identify eligible PSM and RCT studies before July 2021. Data on perioperative and oncological outcomes were subjected to meta-analysis.ResultsOverall, we identified 19 PSM studies and 1 RCT of RG versus LG, enrolling a total of 13,446 patients (6,173 and 7,273 patients underwent RG and LG, respectively). The present meta-analysis revealed nonsignificant differences in tumor size, proximal resection margin distance, distal resection margin distance, abdominal bleeding, ileus, anastomosis site leakage, duodenal stump leakage rate, conversion rate, reoperation, overall survival rate, and long-term recurrence-free survival rate between the two groups. Alternatively, comparing RG with LG, RG has a longer operative time (p < 0.00001), less blood loss (p <0.0001), earlier time to first flatus (p = 0.0003), earlier time to oral intake (p = 0.0001), shorter length of stay (p = 0.0001), less major complications (p = 0.0001), lower overall complications (p = 0.0003), more retrieved lymph nodes (P < 0.0001), and more cost (p < 0.00001).ConclusionsIn terms of oncological adequacy and safety, RG is a feasible and effective treatment strategy for gastric cancer but takes more cost in comparison with LG.

Robotic Versus Laparoscopic Pancreaticoduodenectomy: An Up-To-Date System Review and Meta-Analysis

“…Although robotic surgery is considered to be superior to laparoscopy in several disciplines, including colorectal, gastric, pancreatic, gynecological, and urological procedures, there are some controversies about the safety and efficacy of RPD compared with LPD (23)(24)(25)(26)(27). In order to explore the real efficacy of RPD, this meta-analysis included relevant studies from 2016 to 2021 to explore the safety and effectiveness of RPD and LPD.…”

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

“…Analysis involved all 224 studies: out of them, 193 ones turned as not relevant for title and abstract, while 31 full-texts were considered eligible. Twe of the 31 studies were excluded because they were identified as duplicate publicati After removal of 4 studies not complying with inclusion criteria (1 robotic gastrecto versus open gastrectomy meta-analysis; 1 umbrella review; 1 umbrella review protoc network meta-analysis), 7 meta-analyses underwent qualitative synthesis [14][15][16][17][18][19][20]. No ditional record was found through other source (References list).…”

“…Table 1 shows demographic features of 7 included meta-analyses that covered 2000-2020 time frame [14][15][16][17][18][19][20]. Studies included into the meta-analyses ranged from 12 to 40, were almost all retrospective ones and originated from Asian countries (China and Korea, in particular) [14][15][16][17][18][19][20].…”

“…Table 1 shows demographic features of 7 included meta-analyses that covered 2000-2020 time frame [14][15][16][17][18][19][20]. Studies included into the meta-analyses ranged from 12 to 40, were almost all retrospective ones and originated from Asian countries (China and Korea, in particular) [14][15][16][17][18][19][20]. Examined overall population ranged from 3176 to 17,712 patients; in all studies, the laparoscopic subgroup turned out as more represented than the robotic one [14][15][16][17][18][19][20].…”

“…Studies included into the meta-analyses ranged from 12 to 40, were almost all retrospective ones and originated from Asian countries (China and Korea, in particular) [14][15][16][17][18][19][20]. Examined overall population ranged from 3176 to 17,712 patients; in all studies, the laparoscopic subgroup turned out as more represented than the robotic one [14][15][16][17][18][19][20]. Almost all researches detailed surgical adopted procedure, with a prevalence of distal and total gastrectomy [14][15][16][17][18][19][20].…”