Postoperative outcomes in robotic gastric resection compared with laparoscopic gastric resection in gastric cancer: A meta‐analysis and systemic review

Abstract

Background: Robotic gastrectomy is a commonly used procedure for early gastric cancer and it also overcomes the limitation of laparoscopic. However, the complications of robotic gastrectomy (RG) still need to be assessed. Our study was designed to compare postoperative complications of RG with laparoscopic gastrectomy (LG). Materials and Methods:A meta-analysis and systemic review were prospectively collected using the PubMed, Cochrane Library, and MEDLINE database of published studies by comparing the RG and LG with gastric cancer up to December 2021. To evaluate the postoperative outcomes, odds ratios were calculated for Dichotomous data and the mean difference with 95% confidence interval (CI) was calculated for continuous data, and measured by the random-effect model.Results: Thirty-two retrospective studies describing 13,585 patients (4484 RG and 9101 LG) satisfied the inclusion criteria. A statistically significant result was in blood loss (MD = −17.97, 95% Cl: −25.61 to 10.32, p < 0.001), Clavien−Dindo grade Ⅲ (odds ratio (OR) = 0.60, 95% CI: 0.48−0.76, p < 0.01), and harvested lymph node (MD = 2.62, 95% CI: 2.14−3.11, p < 0.001). There was no significant difference between robotic gastrectomy surgery (RGS) and laparoscopic gastrectomy surgery (LGS) regarding distal resection margin (DRM), proximal resection margin (PRM), conversion rate, anastomotic leakage, and overall complications. Conclusion:Having significant outcomes in Clavien-Dindo grade III, and blood loss, harvested lymph nodes are more common in RGS, and they also help in increasing the quality of life.

The Evolving Surgical Landscape: A Comprehensive Review of Robotic Versus Laparoscopic Gastrectomy for the Treatment of Gastric Cancer

“…Similar outcomes were observed in the same study regarding CD III grade or higher, with the robotic approach having a complication rate of 5.3%, whereas the laparoscopic approach reached 19.7%. The results of Ojima et al [3] agree with the results from Loureiro et al [34], Ali et al [33], and Guerrini et al [24], which observed that the robotic approach decreased the surgical complication rate by 32%, 40%, and 34%, respectively, for CD III grades or higher.…”

“…For instance, Ojima et al concluded that the conversion for the robotic approach was 3.4% versus 1.6% for the laparoscopic approach [3]. However, no statistically significant differences were observed in all the studies [3,5,7,10,11,15,22,24,26,29,[32][33][34]…”

“…Interestingly, five studies reported surgical complications using the Clavien-Dindo scale (CD) [ 3 , 24 , 30 , 33 , 34 ]. Sun et al reported the surgical outcomes for the CD grades I-II and III or higher, which concluded that there was not a statistically significant difference between the two approaches [ 30 ].…”

“…Nine studies reported the rate of anastomotic leakage between the two approaches; however, none reached statistical significance [ 5 , 10 , 11 , 24 , 26 , 27 , 30 , 33 , 34 ]. Moreover, one study reported the outcomes for duodenal stamp leakage [ 26 ], one for anastomosis stenosis [ 21 ], two for intestinal obstruction rate [ 10 , 11 ], and two for ileus [ 26 , 30 ], but none of them reached statistical significance.…”

“…Twenty-two studies reported the overall complication rates, out of which three studies [5,26,29], reported a statistically significant decreased rate of overall complication in favor of the robotic approach, and 19 reported no statistically significant differences between the two approaches [7,8,[11][12][13][14][15][16][17]19,21,23,24,27,[30][31][32][33][34]. Notably, none of the studies seem to favor the laparoscopic over the robotic approach in terms of decreasing the overall complication rate.…”