Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer

Abstract

Objective: To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias. Summary of Background Data: Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG). Methods: Patients (n ¼ 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model. Results: After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P ¼ 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P ¼ 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P ¼ 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P ¼ 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P ¼ 0.498). Conclusions: After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.

Gastrectomía por cáncer gástrico: abordaje mínimamente invasivo

“…La ausencia de conversión a cirugía abierta en este trabajo puede estar explicada por la exclusión de pacientes con lesiones abultadas y con gran carga ganglionar, así como la experiencia previa con el manejo abierto de éstos procedimientos y la utilización frecuente de técnicas mínimamente invasivas en otros procedimientos oncológicos digestivos [34][35][36][37][38] . El tiempo operatorio prolongado en ambos tipos de procedimientos (especialmente en los robóticos), con respecto a los procedimientos abiertos, es una de las desventajas de estas técnicas 39,40 .…”

Robot-assisted laparoscopic subtotal gastrectomy for early-stage gastric cancer: Case series of initial experience

“…Despite RCTs on long-term outcomes are still lacking, many studies [ 37 , [58] , [59] , [60] , [61] , [62] ] reported that robotic gastrectomy for AGC is oncologically adequate when compared to LG or OG. Lately, Shin [ 63 ] demonstrated in a large propensity score-weighted analysis of 2084 consecutive patients underwent RAG vs LAG, no statistical difference in 5-years overall survival and 5-years recurrence-free survival after a mean follow up of 52 months. In a recent meta-analysis, Liao [ 64 ] compared 1009 RG vs 2401 LG with no significant differences in OS, DFS, RFS and recurrence rates between the two groups.…”

Improved management of grade B biliary leaks after complex liver resections using gadoxetic acid disodium–enhanced magnetic resonance cholangiography

“…All the patients had open surgery, and it may be that a move toward laparoscopic surgery could improve these outcomes with several recent studies suggesting comparable long term outcomes 40e42 and the potential for robotic surgery to have an equally effective oncological profile. 43 Although laparoscopic surgery has not been adopted at this center, there has been recent commencement of a robotic program. It has been felt by the surgeons involved that this may confer advantages with excellent visualization and improved surgical dexterity.…”