Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer

Abstract

Objective: A large-scale multicenter retrospective cohort study was conducted to compare the short-and long-term outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. Summary of Background Data: RG is being increasingly used worldwide, but data from large-scale multicenter studies on the short-and long-term oncologic outcomes of RG versus LG are limited. The potential benefits of RG compared with LG for gastric cancer remain controversial. Methods: Data from eligible patients who underwent RG or LG for gastric cancer of 11 experienced surgeons from 7 centers in China between March 2010 and October 2019 were collected. The RG group was matched 1:1 with the LG group by using propensity score matching. The primary outcome was postoperative complications.Results: After propensity score matching, a well-balanced cohort of 3552 patients was included for further analysis. The occurrence of overall complications (12.6% vs 15.2%, P = 0.023) was lower in the RG group than in the LG group. RG was associated with less blood loss (126.8 vs 142.5 mL, P < 0.001) and more retrieved lymph nodes in total (32.5 vs 30.7, P < 0.001) and in suprapancreatic areas (13.3 vs 11.6, P < 0.001). The longterm oncological outcomes were comparable between the two groups. Conclusions: The results of this multicenter study demonstrate that RG is a safe and effective treatment for gastric cancer when performed by experienced surgeons, although longer operation time and higher costs are still concerns about RG. This study provides evidence suggesting that RG may represent an alternative surgical treatment to LG.

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

“…However, the sample size of two meta-analyses was relatively small (6,35), and the study of recurrence-free survival outcome of RG. Compared with their results, our study included some recent studies (27)(28)(29)(30)(31)(32)(33). Noticeably, all the studies are PSM studies, which can minimize selection bias.…”

“…A multicenter cohort study coming from China included 5,402 GC patients. The survival data after PSM of 3,552 patients with GC (1,776 underwent RG and 1,776 underwent LG) suggested that RG and LG can achieve a 5-year overall survival rate of 80.8 and 79.5% years, respectively (p = 0.213), and RG has a 5-year disease-free survival rate similar to that of LG (79.8 vs.78.5%, p = 0.205) (32).…”

Modern surgical therapy for gastric cancer–Robotics and beyond

“…Robotic TG also showed no survival difference compared to laparoscopic TG 51 . Recently, a large‐scale multicenter retrospective cohort study in China was conducted to compare the surgical outcomes of RG and LG 52 . The long‐term oncologic outcomes were comparable between the groups when performed by experienced surgeons 52 .…”

“…Recently, a large‐scale multicenter retrospective cohort study in China was conducted to compare the surgical outcomes of RG and LG 52 . The long‐term oncologic outcomes were comparable between the groups when performed by experienced surgeons 52 . Additionally, even in obese patients with advanced gastric cancer who have undergone D2 dissection, the robotic group showed favorable short‐term outcomes as well as significantly better relapse‐free survival than the open and laparoscopic groups 47 .…”

Benefits of minimally invasive surgery in the treatment of gastric cancer

“…Another aspect highlighted is a lower risk of dehiscence of the esophagus-jejunal anastomosis, along with a lower incidence of internal hernias[ 9 - 11 ]. From the short-term results it emerges that robotic gastrectomy is a safe technique that potentially allows to extend the number of patients treatable with a minimally invasive approach, overcoming the technical difficulties of laparoscopy, offering some benefits in terms of blood loss, conversion rate, overall number of lymph nodes removed and in suprapancreatic areas, procedure-specific postoperative morbidity and shorter length of hospital stay[ 12 ].…”