Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes

Shen, Weisong; Xi, Hongqing; Wei, Bo; Cui, Jianxin; Bian, Sainan; Zhang, Kecheng; Wang, Ning; Huang, Xiaohui; Chen, Lin

doi:10.1007/s00464-015-4241-7

Cited by 85 publications

(64 citation statements)

References 29 publications

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“…For example, Vinuela et al [24] performed a meta-analysis of all English-language studies since 1992, including several from Eastern centers, and found that when they compared open versus laparoscopic distal gastrectomy outcomes, the former were associated with better lymph node harvest quantitatively, but no difference was seen in the odds of having less than the recommended minimum of lymph nodes on the basis of the approach alone. With regard to R0 resection rates, Shen et al's [21] findings concurred with those of the present study. Perhaps the more clinically significant observation is that newer, minimally invasive technology is noninferior to the standard open procedure and potentially offers faster healing, fewer wound complications, and an earlier use of adjuvant therapy.…”

Section: Discussionsupporting

confidence: 91%

“…Proponents of robotic technology, in particular, cite greater technical precision, more degrees of freedom in instrument articulation, and better visualization of anatomy relative to other surgical approaches [10]. With most of the experience and literature regarding surgery for gastric cancer coming from the East, previously published studies show a greater quantity of lymph nodes harvested during minimally invasive surgery, yet there is a general lack of consensus regarding improved R0 resection rates on the basis of the approach alone [11,[19][20][21][22][23]. For example, Vinuela et al [24] performed a meta-analysis of all English-language studies since 1992, including several from Eastern centers, and found that when they compared open versus laparoscopic distal gastrectomy outcomes, the former were associated with better lymph node harvest quantitatively, but no difference was seen in the odds of having less than the recommended minimum of lymph nodes on the basis of the approach alone.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive surgery for gastric cancer: the American experience

et al. 2016

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Background Minimally invasive surgical techniques are increasingly being implemented in oncologic care. This study assesses the impact of minimally invasive surgery on oncologic and perioperative outcomes in the management of gastric cancer in the USA. Methods From the American College of Surgeons and American Cancer Society National Cancer Data Base, we identified 6427 patients who underwent gastrectomy for cancer from 2010 to 2012. Treatment groups were categorized with an intention-to-treat paradigm as robotic, laparoscopic, and open surgery. Univariate and multivariate analyses were performed to estimate the impact of the surgical approach on oncologic and perioperative outcomes. Results Of patients undergoing definitive surgical intervention, 3.5 % (n = 223) underwent robotic gastrectomy, 23.1 % (n = 1487) underwent laparoscopic gastrectomy, and 73.4 % (n = 4717) underwent open surgery. Minimally invasive gastrectomy was more frequently performed on white (P = 0.018), privately insured patients (P = 0.049) treated at academic centers (P \ 0.0001) in the eastern USA (P \ 0.0001). After demographics, comorbidities, and tumor-related factors had been controlled for, patients who underwent laparoscopic gastrectomy had the postoperative length of stay decreased by 1.08 days (P \ 0.0001) and greater odds of having at least 15 lymph nodes resected (odds ratio 1.16, P = 0.023). Use of robotic surgery did not have a statistically significant effect on the postoperative length of stay relative to open surgery (P = 0.222) but the patients so treated had greater odds of having at least 15 lymph nodes resected (odds ratio 1.51, P = 0.005). There were no differences in R0 resection rates or perioperative mortality on the basis of the surgical approach alone. Conclusions These findings suggest that use of minimally invasive surgery for gastric cancer in the USA is impacting the adequacy of oncologic resection but is not yet having a clinically significant impact on perioperative outcomes relative to a conventional open approach.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for gastric cancer: the American experience

et al. 2016

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“…Oncological outcomes other than survival or recurrence, such as the number of lymph nodes harvested and margin status, are reported to be similar between robotic and laparoscopic approaches30 (Table 1). However, a potential advantage of robotic surgery was found in carrying out D2 lymphadenectomy.…”

Section: Oncological Outcomesmentioning

confidence: 96%

Robotic gastrectomy for gastric cancer: Current evidence

Alhossaini

Altamran

Seo

et al. 2017

Annals of Gastroent Surgery

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The robotic system has gained wide acceptance in specialties such as urological and gynecological surgery. It has also been applied in the field of upper gastrointestinal surgery. Since the first implementation of the robotic system for the treatment of gastric adenocarcinoma, the procedure has been found to be safe and feasible. Although robotic gastrectomy does not meet our expectations and yield better results than laparoscopic gastrectomy, this procedure seems to provide several advantages over laparoscopy such as reduced blood loss, shorter learning curves and increased number of retrieved lymph nodes. However, as many case series, including a recent multicenter study, have revealed, higher cost and longer operation time are the major limitations of robotic gastrectomy. Furthermore, there are no results from well‐designed randomized clinical trials comparing the two procedures. New procedures in much more technically demanding cases will test the genuine benefits of robotic gastrectomy.

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“…On the contrary, robotic surgery shows comparable or better retrieval of lymph nodes than laparoscopy (16,17,19,21,23,25). The reduced number of retrieved lymph nodes is the one single weakness of laparoscopic surgery, compared with open surgery, for which robotic systems can compensate.…”

Section: Higher Number Of Retrieved Lymph Nodesmentioning

confidence: 99%

“…In robotic gastrectomy, about half of all publications report less bleeding than that in laparoscopic surgery (7,17,20,(23)(24)(25)(26)(27)(28). Statistically, less bleeding may have no impact on the clinical course of the patients; however, it implies that robots offer more precise dissection of the lymph nodes following the surgical plane.…”

Section: Less Bleedingmentioning

confidence: 99%

Robotic surgery for gastric tumor: current status and new approaches

Lim

Lee

Son

et al. 2016

Transl. Gastroenterol. Hepatol.

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Surgical techniques have evolved tremendously over this past century. To maximize the efficacy and minimize the invasiveness of laparoscopic surgery, researchers have sought to implement wider application of robotics. Nevertheless, both optimism without sound evidence and fear of new technology obscure the appropriate uses of robotic surgery. In the present review, we attempted to provide a balanced perspective on the current state of robotic gastrectomy, outlining evidence and opportunities for the use thereof. Although evidence is limited, the use of robotics is feasible for gastric cancer surgery, and less than 10 cases of robotic surgery are needed to become proficient therein. Compared to the clinical impact of laparoscopy on gastric cancer surgery, the additional benefits of robotic surgery to patients seem to be limited. Despite additional costs and longer surgeries, robotic surgery reportedly does not offer surgical outcomes superior to those for laparoscopic surgery, according to a recent multicenter study.Meanwhile, however, our in-depth review of retrospective and prospective reports revealed that robots could expand the indications of minimally invasive gastrectomy for patients requiring total gastrectomy and D2 lymph node dissection. Moreover, we found that robotic gastrectomy is associated with a higher number of retrieved lymph nodes, less bleeding, fewer complications, and shorter hospital stay, compared to laparoscopic gastrectomy. Accordingly, new surgical approaches using advanced technologies, such as near infrared detectors, the Tilepro ® multi-input display, dual consoles, and the Single-Site ® system, are under investigation. In conclusion, measuring the additional benefits of robotic over laparoscopic surgery would be difficult and clinically insignificant. Thus, developing new surgical procedures that extend the benefits of conventional laparoscopic surgery to patients in whom minimally invasive surgery would not be possible is necessary to justify the greater use of robotic surgery.

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Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes

Cited by 85 publications

References 29 publications

Minimally invasive surgery for gastric cancer: the American experience

Minimally invasive surgery for gastric cancer: the American experience

Robotic gastrectomy for gastric cancer: Current evidence

Robotic surgery for gastric tumor: current status and new approaches

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