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

Abstract

Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment. However, LG suffers from technical limitations and drawbacks, such as a two-dimensional surgical field of view, limited movement of laparoscopic tools, unavoidable physiological tremors and discomfort for operating surgeon. Therefore, robotic surgery has been developed to address such limitations. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines in order to investigate the benefits and harms of robotic gastrectomy (RG) compared to the LG. PubMed/MEDLINE, Scopus, Cochrane Library (Cochrane Database of Systematic Re-views, Cochrane Central Register of Controlled Trials-CENTRAL) and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature. Results: The 7 included meta-analyses covered an approximately 20 years-study period (2000–2020). Almost all studies included in the meta-analyses were retrospective ones and originated from Asian countries (China and Korea, in particular). Examined overall population ranged from 3176 to 17,712 patients. If compared to LG, RG showed both operative advantages (operative time, estimated blood loss, number of retrieved lymph nodes) and perioperative ones (time to first flatus, time to restart oral intake, length of hospitalization, overall complications, Clavien-Dindo (CD) ≥ III complications, pancreatic complications), in the absence of clear differences of oncological outcomes. However, costs of robotic approach appear significant. Conclusions: It is impossible to make strong recommendations, due to the statistical weakness of the included studies. Further randomized, possibly multicenter trials are strongly recommended, if we want to have our results confirmed.

Save our surgeons (SOS) – an explorative comparison of surgeons’ muscular and cardiovascular demands, posture, perceived workload and discomfort during robotic vs. laparoscopic surgery

“…Robotic surgery has gained popularity and significance in MIS over the last few years and clinicians hope to further expand on the recognized advantages of the laparoscopic surgical technique for patients [ 7 ]. In this context, many scientific papers have reported on patient outcomes and surgical data when applying robotic surgery which has been summarized in recent systematic reviews [ 8 , 9 ]. In addition, it is presumed that robotic surgery provides ergonomic benefits for surgeons by reducing physical demands [ 10 ].…”

Laparoscopic vs open surgery for gastric cancer: Assessing time, recovery, complications, and markers

“…For early GC, surgical treatment is mainly performed in clinical practice[ 12 ]. Open surgery can directly remove the focus lesion; however, it results in higher incidence of complications owing to large trauma, more intraoperative bleeding, long recovery time, poor prognosis, complex tissue structure around the stomach, difficult operation procedure, and long exposure time of the organs[ 13 , 14 ]. Therefore, developing a surgical method with less trauma, quick recovery, and minimal impact on immunity is of great practical importance.…”

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

“…The evaluation of time to first flatus in robotic gastrectomy versus laparoscopic gastrectomy revealed a range of findings among the 15 studies that examined it. Overall, nine out of the 15 studies reported a statistically significant decrease in time to the first flatus, in favor of the robotic approach [ 5 , 7 , 8 , 23 , 15 , 26 , 29 , 30 , 34 ]. Notably, Bobo et al [ 7 ] concluded that the time to first postoperative flatus was 0.14 days shorter for the robotic group, with Jin et al [ 29 ] and Yu et al [ 8 ] further backing up this claim (-0,105 and -0.16 days, respectively).…”

“…Regarding the time required to initiate oral intake, a clear trend across the eleven studies is evident. Ten studies [ 5 , 8 , 10 , 17 , 24 , 26 , 27 , 30 , 32 , 34 ] concluded that the patients who underwent robotic gastrectomy initiated oral intake earlier than those in the laparoscopic cohorts. Particularly, Guerrini et al reported that the robotic group required 4.25 days to initiate oral intake, while the laparoscopic required 4.45 days [ 24 ].…”

“…Whilst analyzing the reoperation rates in six studies comparing robotic and laparoscopic gastrectomy, a stable trend emerges. It is evident that (a) the reoperation rate is very low in both approaches, notably 1.29% in the robotic and 1.23% in the laparoscopic [ 24 ], and (b) the differences in the reoperation rates are not statistically significant [ 5 , 7 , 24 , 26 , 29 , 34 ]. These results provide reassurance about the overall efficacy and safety of both approaches; however, the number of studies that compared the reoperation rates was only six, substantially lesser compared to studies that compared other outcomes (i.e.)…”