Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study

Abstract

BackgroundRobotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study was designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer.MethodsBetween June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were performed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical performance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared between the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated.ResultsThere were no significant differences in patient characteristics between the two groups. Mean tumor size was larger in the laparoscopic than in the robotic patients (5.3 ± 0.5 cm and 3.0 ± 0.4 cm, respectively; P = 0.02). However, tumor stage distribution was similar between the two groups. The mean number of dissected lymph nodes was higher in the robotic than in the laparoscopic patients (39.1 ± 3.7 and 30.5 ± 2.0, respectively; P = 0.02). The mean operative time was 262.6 ± 8.6 min in the laparoscopic group and 312.6 ± 15.7 min in the robotic group (P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic and in the robotic patients. There were no significant differences in short-term clinical outcomes between the two groups.ConclusionsWithin the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal gastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic surgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and examined lymph nodes.

Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis

“…Recently,robot-assisted surgery,an emerging technology,has been used to overcome the technical drawbacks of conventional laparoscopic surgery.Advantages of robot-assisted surgery include high de nition 3-D stereo video,convenient movements of the robotic arm,tremor suppression,and stable picture [14][15][16].Application of the Da Vinci robotic surgical system has unlocked a new era of MIS,and it has been widely used in cardiovascular,urinary tract, hepatobiliary and gynecological surgery [17].Since Hashizume et al [18] reported the rst RG in 2002,studies on RG have been widely reported.…”

Jianpi Bushen, a Traditional Chinese Medicine Therapy, Combined with Chemotherapy for Gastric Cancer Treatment: A Meta‐Analysis of Randomized Controlled Trials

“…The high incidence and mortality of gastric cancer make it one of the most deadly of cancers. The primary clinical treatment is surgery, which increases the survival rate of patients within five years after treatment [1]. …”

“…Some reports have shown that gastric cancer patients that underwent resection or radical surgery subsequently suffered from residual tumor metastasis, malnutrition, and other complications, due to the effects of surgical trauma on the immune function, making surgery a less preferred option for patients with compromised immunity [1]. Another study reported that disease progression of tumor cells can be slowed down by the release of an immunosuppressive agent induced by postoperative tissue damage.…”

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“…This is in addition to the finding of lower estimated blood loss on the robotic group [55]. In fact, as the learning curve for robotic gastric resections is surpassed, the D2 lymphadenectomy yield improves and is superior to the laparoscopic outcome [56]. These observations made by the experts in this field are a testament to the fact that the robotic technology enables the surgeon to refine the technique to the point that, regardless of the level of difficulty required for this type of procedure, it is possible to continue to improve as the case volume increases.…”