Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis

Abstract

BackgroundRobotic gastrectomy (RG) is a new surgical method alternative for gastric cancer. However, few studies have evaluated the outcomes of RG for advanced gastric cancer (AGC). Thus, the aim of this study was to compare the short-and long-term outcomes of RG and laparoscopic gastrectomy (LG) with D2 lymph node dissection for AGC.Patients and methodsWe retrospectively evaluated 454 patients with AGC who underwent RG or LG with D2 lymph node dissection for AGC between August 2013 and March 2017. The short-and long-term outcomes were compared between the propensity score-matched groups.ResultsThe RG group was associated with longer operation time, less intraoperative blood loss, and higher hospital cost. Additionally, there was a tendency favoring RG in terms of number of harvested lymph nodes, time to first flatus, time to first start diet, and postoperative hospital stay, although the differences were not statistically significant. The overall postoperative complication rate was 13.4% and 11.6% in the RG and LG groups, respectively, with no significant difference (P=0.686). The 3-year overall survival and recurrence rates of the RG and LG groups were also comparable (78.6% vs 74.1%, P=0.483; 18.8% vs 21.4%, P=0.617; respectively).ConclusionRG with D2 lymph node dissection is safe and feasible for AGC in terms of both short- and long-term outcomes. High-volume randomized controlled trials with sufficient follow-up are needed to confirm this rationale.

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

“…After a thorough review of the full text of the 10 papers, one paper was excluded because it was a letter [13], and another study was excluded because the survival data were insufficient for analysis [14]. Finally, eight papers were included for our meta-analysis [15][16][17][18][19][20][21][22]. The study selection process is shown in Fig.…”

“…Only one study reported DFS results [16]; there was no significant difference between the two groups in DFS, the HR was 1.08 with a 95% CI from 0.26 to 4.44, and the P value was 0.67. Four studies [15][16][17]20]. A meta-analysis of the four studies indicated that the two techniques had similar RFS outcomes (HR, 0.92; 95% CI, 0.72-1.19; P = 0.53).…”

“…All of the included studies reported OS outcomes [15][16][17][18][19][20][21][22]. The pooled data from the eight studies indicated no significant difference between the two groups (HR, 0.98; 95% CI, 0.80-1.20; P = 0.81), and a fixed-effects model was adopted due to the lack of significant heterogeneity (I 2 = 0, P = 0.94, Fig.…”

“…The two techniques had a comparable LOS (MD, − 0.24; 95% CI, − 0.60 to 0.11; P = 0.16) based on the pooled data from all the included studies [12,[15][16][17][18][19][20][21][22], and a fixed-effect model was adopted because there was no heterogeneity ( Fig. 3a).…”

“…Three papers performed PSM analyses. We conducted a sensitivity analysis for papers that performed PSM analyses [15][16][17]. In terms of OS, the results showed that there was no significant difference between the two techniques (HR, 1.06; 95% CI, 0.81-1.38; P = 0.69) (Fig.…”