Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy

Park, J.M.; Kim, H.I.; Han, Sang‐Uk; Yang, Han Kwang; Kim, Y.W.; Lee, H.J.; An, Ji Yeong; Kim, M.C.; Park, Seonyoung; Song, Kyo Young; Oh, Sung Jin; Kong, Seong Ho; Suh, Byoung Jo; Yang, Dae Hyun; Ha, Tae Kyung; Hyung, Woo Jin; Ryu, Keun Won

doi:10.1016/j.ejso.2016.07.012

Cited by 59 publications

(33 citation statements)

References 24 publications

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“…Robotic surgery is thought to be superior to laparoscopy in different disciplines, including urological,[22] gynecological,[23] colorectal,[24] gastric,[25] and distal pancreatic operations,[26] but none have compared RPD to LPD in a large study,[19] as few institutions perform this complex operation using minimally invasive techniques, and the majority have adopted one approach versus the other, preventing single institutional comparison. The robotic platform provides a magnified three-dimensional image, 7 degrees of freedom, and eliminates hand tremor and the fulcrum effect of rigid laparoscopic instruments—allowing for precise suturing, easier tissue handling, better control of large blood vessels, and the ability to work at angles not possible with the laparoscope.…”

Section: Discussionmentioning

confidence: 99%

Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Nassour

Wang

Porembka

et al. 2017

Journal of Gastrointestinal Surgery

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Background An increasing body of literature is supporting the safety of minimally invasive pancreaticoduodenectomy compared to open pancreaticoduodenectomy, but there are limited comparative studies between laparoscopic and robotic pancreaticoduodenectomy. The aim of this study was to compare the rate of postoperative 30-day overall complications between laparoscopic and robotic pancreaticoduodenectomy. Methods Patients who underwent laparoscopic and robotic pancreaticoduodenectomy were abstracted from the 2014–2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. A multivariable logistic regression model was developed to determine if the type of minimally invasive approach was associated with 30-day overall complications. Results We identified 428 minimally invasive pancreaticoduodenectomy cases, of which 235 (55%) were performed laparoscopically and 193 (45%) robotically. Patients who underwent the robotic approach were more likely to be white compared to those who underwent laparoscopic, and less likely to have pulmonary disease, undergo preoperative radiotherapy, and have vascular and multivisceral resection. On multivariable analysis, we found that the type of minimally invasive approach, whether laparoscopic or robotic, was not associated with overall complications. The predictors of 30-day overall complications were higher body mass index (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02–1.09), vascular resection (OR, 2.10; 95% CI, 1.23–3.58), and longer operative time (OR, 1.002; 95% CI, 1.001–1.004). Conclusions Robotic pancreaticoduodenectomy was associated with a similar 30-day overall complication rate to laparoscopic pancreaticoduodenectomy. Further studies are needed to corroborate these findings and to establish the best approach to perform this complex operation.

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Section: Discussionmentioning

confidence: 99%

Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Nassour

Wang

Porembka

et al. 2017

Journal of Gastrointestinal Surgery

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“…They also reported significantly higher total cost in the RG group (US$13,432) than the LG group (US$8,090). Park et al conducted a subset analyses of this study, and found that RG may be beneficial for patients undergoing D2 lymphadenectomy, although they failed to show the benefit of RG in patients undergoing total gastrectomy or those with obesity (46).…”

Section: Prospective Studiesmentioning

confidence: 81%

Robotic gastrectomy for gastric cancer

Tokunaga

Kaito

Sugita

et al. 2017

Transl. Gastroenterol. Hepatol.

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Correspondence to: Masanori Tokunaga. 6-5-1, Kashiwanoha, Kashiwa, 277-8577 Japan. Email: mtokunag@east.ncc.go.jp.Abstract: The number of robotic gastrectomy (RG) performed per year has been increasing, particularly in East Asia where the incidence of gastric cancer is high and approximately half of the cases are diagnosed as early gastric cancer. With articulated devices of RG, surgeons are able to perform every procedure more meticulously, which can result in less bleeding and damage to organs. There are many single arm and comparative studies, and these study showed similar trends, which included relatively less estimated blood loss and longer operation time following RG than laparoscopic gastrectomy (LG), equivalent number of harvested lymph nodes and similar length of postoperative hospital stay between RG and LG. Considering the results of these retrospective comparative studies, RG seems to be as feasible as LG in terms of early surgical outcomes. However, medical expense of RG is approximately twice as much as that of LG. Lack of solid evidence in terms of long-term outcomes is another problem. Considering the higher medical expenses associated with RG, its superiority in terms of long-term survival outcomes needs to be confirmed in the future for it to be accepted more widely.

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“…A recent multicenter nonrandomized prospective comparative study of robotic versus laparoscopic gastrectomy for gastric cancer showed that estimated blood loss was similar between the two groups [14]. A subgroup analysis of that study showed that the robotic group had significantly lower estimated blood loss than the laparoscopic group during D2 lymph node dissection [30]. Lee et al reported that in terms of blood loss, the benefits of a robotic approach were more apparent for high BMI patients when performing a distal gastrectomy with D2 lymph node dissection [25].…”

Section: Issues Regarding Robotic Gastrectomymentioning

confidence: 99%

“…The importance of complete suprapancreatic lymph node dissection in advanced disease had been shown to improve oncological outcomes [54]. In the subgroup analysis of a multicenter prospective comparative study, the robotic gastrectomy group showed significantly lower estimated blood loss than the laparoscopic gastrectomy group after D2 lymph node dissection (98.9 ± 105.7 versus 140.5 ± 143.1; p = .021), whereas no difference in estimated blood loss was observed in patients that underwent less extensive lymph node dissection (96.5 ± 144.2 versus 82.6 ± 91.7; p = .365) [30]. In addition, a recent report showed that robotic gastrectomy is safe in terms of the incidence of postoperative pancreatic fistulas, compared with laparoscopic gastrectomy, following suprapancreatic lymph node dissection (10% versus 22.5%; p < .001) [55].…”

Section: Application For Technically Demanding Proceduresmentioning

confidence: 99%

“…Lee et al suggested that robotic surgery was better than laparoscopic gastrectomy with respect to the rate of adequately retrieved lymph nodes (more than 15 retrieved lymph nodes) in high BMI patients [25]. However, a recent report of a multicenter prospective study did not observe additional benefits using robotic procedures for obese patients compared with laparoscopic surgery [30]. Thus, the impact of robotic surgery in obese patients remains controversial.…”

Section: Application For Technically Demanding Proceduresmentioning

confidence: 99%

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Status and Prospects of Robotic Gastrectomy for Gastric Cancer: Our Experience and a Review of the Literature

Lee

Son

Kim

et al. 2017

Gastroenterology Research and Practice

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Since the first report of robotic gastrectomy, experienced laparoscopic surgeons have used surgical robots to treat gastric cancer and resolve problems associated with laparoscopic gastrectomy. However, compared with laparoscopic gastrectomy, the superiority of robotic procedures has not been clearly proven. There are several advantages to using robotic surgery for gastric cancer, such as reduced estimated blood loss during the operation, a shorter learning curve, and a larger number of examined lymph nodes than conventional laparoscopic gastrectomy. The increased operation time observed with a robotic system is decreasing because surgeons have accumulated experience using this procedure. While there is limited evidence, long-term oncologic outcomes appear to be similar between robotic and laparoscopic gastrectomy. Robotic procedures have a significantly greater financial cost than laparoscopic gastrectomy, which is a major drawback. Recent clinical studies tried to demonstrate that the benefits of robotic surgery outweighed the cost, but the overall results were disappointing. Ongoing studies are investigating the benefits of robotic gastrectomy in more complicated and challenging cases. Well-designed randomized control trials with large sample sizes are needed to investigate the benefits of robotic gastrectomy compared with laparoscopic surgery.

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Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy

Cited by 59 publications

References 24 publications

Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Robotic gastrectomy for gastric cancer

Status and Prospects of Robotic Gastrectomy for Gastric Cancer: Our Experience and a Review of the Literature

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