Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis

Abstract

Background. We compared the outcomes of laparoscopic-assisted (LA) and robotic-assisted (RA) gastrectomies performed for gastric adenocarcinoma in the National Cancer Database. Methods. The National Cancer Database was queried for patients 18 years old with stages I to III gastric adenocarcinoma who underwent LA or RA gastrectomy. Propensity matching was performed between the 2 groups with regard to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results. A cohort of 1893 (1262 = LA, 631 = RA) patients was identified in a 2:1 propensity matching. The groups were well matched. The rate of negative margin as well as 30- and 90-day mortality were similar between the 2 cohorts. Long-term survival was similar between the 2 groups (median survival 49.2 months in LA vs 56.2 months for RA, P = .405). However, the average number of lymph nodes (LNs) sampled was significantly higher in the RA group compared with the LA group (19.6 vs 17.4, P < .001). Similarly, the percentage of surgeries in which ≥15 LNs were sampled was also greater in the RA group compared with the LA group (63.9% vs 57.6%, P = .010). On multivariable analysis, having 15 LNs or more examined was associated with better survival (hazard ratio = 0.72, 95% confidence interval = 0.60-0.87, P < .001). Advanced age, nodal positivity, and advanced clinical stages were significantly associated with worse survival. Conclusions. RA gastrectomy may allow a greater harvest of LNs, and thus more accurate staging, without increasing short-term adverse outcomes compared with LA gastrectomy. Short-term and long-term outcomes in this well-matched cohort appear comparable for both approaches.

Safe implementation of robotic gastrectomy for gastric cancer under the requirements for universal health insurance coverage: a retrospective cohort study using a nationwide registry database in Japan

“…In this study, the 30-day mortality of LG (LG, 0.1%; LDG, 0.0%; LTG, 0.8%), was better than reported in the other large database studies (US National Cancer Database [ 37 ], 2.7%; Japanese NCD [ 11 , 18 , 19 ], 0.2–0.9%); however, it did not differ from RG (RG, 0.2%; RDG, 0.2%; RTG, 0.5%). A similar trend was observed in the estimated blood loss and readmission rate.…”

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.…”

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

“…Since these specific considerations and the importance to perform an adequate lymphadenectomy to reduce loco-regional recurrence and gastric cancer-related death [ 32 ], the robotic surgical system should be considerate an opportunity to overcome some of the major drawbacks of conventional laparoscopy. After an initial experience [ 11 , 12 ], several authors [ [33] , [34] , [35] , [36] , [37] , [38] , [39] ] demonstrated that robot-assisted laparoscopy gastrectomy is safe and feasible, with reduction in operative blood loss [ 34 ], longer operative time, lesser postoperative morbidity rate [ 16 , 40 ] and no difference in terms of harvested lymph-nodes when compared to laparoscopic and open approach [ 41 ]. The da Vinci system allows surgeon to perform a precise dissection of extra-gastric lymph-nodes, particularly in “difficult” stations such as no.7, 8, 9, 11p and 12a.…”