Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

Abstract

Background Few studies have been designed to evaluate the short-term outcomes for advanced gastric cancer (AGC) between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) alone. The purpose of this study was to assess short-term outcomes of RATG compared with LATG for AGC.Methods We retrospectively evaluated 116 and 244 patients who underwent RATG or LATG respectively. Besides, we performed a propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes.Results After PSM, the RTAG group had longer mean operation time (291.09±58.41 vs. 271.99±48.41min, p=0.007), less intraoperative bleeding (151.98±92.83 vs. 172.59±97.01ml, p=0.032) and more N2 tier RLNs (9.33±5.46 vs. 7.50±3.86, p=0.018) than the LATG group. Besides, the total RLNs of RATG was at the brink of significance compared to LATG (35.09±12.93 vs.32.34±12.05, p=0.062). However, no significant differences were found between the two groups in terms of length of incision, proximal resection margin, distal resection margin, postoperative hospital stay. The conversion rate was 4.92% and 8.61% in the RATG and LATG groups, respectively, with no significant difference. The ratio of splenectomy was 1.7% and 0.4% respectively. There was no significant difference in overall complication rate between RATG and LATG groups before PSM (24.1% vs. 28.7%; p=0.341) and after PSM (24.1% vs. 33.6%; p=0.102). The grade II complications accounted for most of all complications in the two cohorts both before and after PSM.Conclusion This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients

“…This finding could be attributed to the advanced robotic surgery systems, including an internal EndoWrist with seven degrees of freedom, three-dimensional vision, tremor filter, and short learning curve, which prevented injuries from the blood vessels and allowed precise dissection and high flexibility for surgeons [32]. Previous studies proved that one critical barrier to the wide RG application in clinical practice was high costs [12,13,16,17,33,34]. Our study also found that RADG group had higher medical cost than the LADG group.…”

“…Although several studies have reported the postoperative complications, the results are still elusive [16,[38][39][40]. A previous study demonstrated that RG showed similar postoperative morbidity to that of LG [16].…”

“…Although several studies have reported the postoperative complications, the results are still elusive [16,[38][39][40]. A previous study demonstrated that RG showed similar postoperative morbidity to that of LG [16]. A recent meta-analysis also revealed no significant differences in the overall or severe complication rates between robotic and laparoscopic groups [30].…”

“…Additionally, a robotic surgical system has been introduced to address the limitations of laparoscopy and is welcomed in GC treatment owing to its satisfying early postoperative outcomes [13,[15][16][17]. Robotic gastrectomy (RG) has been confirmed to be a safe and feasible technique with better anatomical and operative conditions and comparable long-term results compared to LG [12,15,[18][19][20].…”

Comparison of the prognosis of robotic-assisted total gastrectomy, laparoscopic total gastrectomy, and conventional open total gastrectomy: A network meta-analysis

“…the study by Yang C et al also showed better short-term outcomes with robotic-assisted treatment, again demonstrating the advantages of robotic total gastrectomy in causing a less severe intraoperative inflammatory response and faster recovery of patients after surgery. [36] On the other hand, the high cost of surgery for robot-assisted treatment of gastric cancer is one of its drawbacks. However, there is a paucity of literature comparing the costs of the three surgical procedures, so this outcome indicator has not been included.…”