A meta-analysis of robotic gastrectomy versus open gastrectomy in gastric cancer treatment

Chen, Lei; Wang, Qian; Yu, Lei; Wang, Yonghong; Li, Yaping; Dan, Jie; Wang, Jian

doi:10.1016/j.asjsur.2021.07.069

Cited by 8 publications

(17 citation statements)

References 22 publications

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“…Although the propensity‐matched study from Solaini et al 51 reported statistically similar rates of recovery, Wang et al 21 reported faster times to first flatus (RG vs. OG, 2.6 vs. 3.1 days; p = .03) and shorter LOS (RG vs. OG, 5.7 vs. 6.5 days; p = .02) for the robotic group. These findings were corroborated in meta‐analyses 49,50 …”

Section: Surgical Approachesmentioning

confidence: 53%

“…Postoperative complication rates have demonstrated statistical equivalence or have favored robotic operations. Although the RCT by Wang et al 21 and the meta‐analysis by Caruso et al 50 showed no statistical difference in overall morbidity, another meta‐analysis reported a lower likelihood with RG (odds ratio, 0.57; p = .025) 49 . Conflicting results were also demonstrated in two Western single‐institution studies that included patients who had previously received NAC 51,52 …”

Section: Surgical Approachesmentioning

confidence: 99%

“…A Chinese RCT, 21 which included both DG and TG, likewise reported longer OR times in the robotic cohort (243 vs. 192 minutes; p = .002). Multiple studies reported significantly lower EBL for robotic cases, although none of those studies included patients who had received NAC 21,40,49,50 …”

Section: Surgical Approachesmentioning

confidence: 99%

“…Multiple studies reported significantly lower EBL for robotic cases, although none of those studies included patients who had received NAC. 21,40,49,50 Postoperative complication rates have demonstrated statistical equivalence or have favored robotic operations. Although the RCT by Wang et al 21 and the metaanalysis by Caruso et al 50 showed no statistical difference in overall morbidity, another meta-analysis reported a lower likelihood with RG (odds ratio, 0.57; p = .025).…”

Section: Isuor Ricgl Fusicfmcamentioning

confidence: 99%

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Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

Ong

Schwarz

Roggin

2022

Cancer

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Despite high mortality rates from gastric cancer, surgical management remains critical for curative potential. Optimal outcomes of gastric cancer resection depend on a multitude of variables, including the extent of resection, scope of lymphadenectomy, method of reconstruction, and potential for a minimally invasive approach. Laparoscopic gastrectomy, compared with open gastrectomy, has been analyzed in numerous randomized control trials. Generally, those trials demonstrated statistically similar postoperative complication rates, mortality, and oncologic outcomes between the two approaches. Although laparoscopic gastrectomy requires longer operative times, significant improvements in estimated blood loss, postoperative length of stay, and return of bowel function have been noted in patients who undergo laparoscopic gastrectomy. These short-term benefits, along with equivalent oncologic results, have influenced national guidelines in both Eastern and Western countries to recommend laparoscopy, especially for early stage disease. Although robotic gastrectomy has not been as widely validated in effective trials, studies have reported equivalent oncologic outcomes and similar or improved postoperative complication and recovery rates after robotic gastrectomy compared with open gastrectomy. Comparing the two minimally invasive gastrectomy approaches, robotic surgery was associated with improved estimated blood loss, incidence of pancreatic sequela, and lymph node harvests in some studies, whereas laparoscopy resulted in lower operative times and hospital costs. Ultimately, when applying outcomes from the literature to clinical patient care decisions, it is imperative to recognize these studies' range of inclusion criteria, delineating between patients originating from Eastern or Western countries, the use of neoadjuvant chemotherapy, the volume of surgeon experience, and the extent of gastrectomy, among others.

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Section: Surgical Approachesmentioning

confidence: 53%

Section: Surgical Approachesmentioning

confidence: 99%

Section: Surgical Approachesmentioning

confidence: 99%

Section: Isuor Ricgl Fusicfmcamentioning

confidence: 99%

See 2 more Smart Citations

Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

Ong

Schwarz

Roggin

2022

Cancer

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“…At present, an increasing number of studies has been exploring RG safety and effectiveness in GC treatment [8]. Several studies proved that GC treatment through RG is both safe and feasible, while its healing consequences are similar to those of OG, although it requires higher surgical skills and longer times [8,21]. However, RG safety and efficacy in comparison to LG ones are strongly debated in the treatment of GC.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

et al. 2022

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Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment. However, LG suffers from technical limitations and drawbacks, such as a two-dimensional surgical field of view, limited movement of laparoscopic tools, unavoidable physiological tremors and discomfort for operating surgeon. Therefore, robotic surgery has been developed to address such limitations. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines in order to investigate the benefits and harms of robotic gastrectomy (RG) compared to the LG. PubMed/MEDLINE, Scopus, Cochrane Library (Cochrane Database of Systematic Re-views, Cochrane Central Register of Controlled Trials-CENTRAL) and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature. Results: The 7 included meta-analyses covered an approximately 20 years-study period (2000–2020). Almost all studies included in the meta-analyses were retrospective ones and originated from Asian countries (China and Korea, in particular). Examined overall population ranged from 3176 to 17,712 patients. If compared to LG, RG showed both operative advantages (operative time, estimated blood loss, number of retrieved lymph nodes) and perioperative ones (time to first flatus, time to restart oral intake, length of hospitalization, overall complications, Clavien-Dindo (CD) ≥ III complications, pancreatic complications), in the absence of clear differences of oncological outcomes. However, costs of robotic approach appear significant. Conclusions: It is impossible to make strong recommendations, due to the statistical weakness of the included studies. Further randomized, possibly multicenter trials are strongly recommended, if we want to have our results confirmed.

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Postoperative outcomes in robotic gastric resection compared with laparoscopic gastric resection in gastric cancer: A meta‐analysis and systemic review

Ali

Wang

Ding

et al. 2022

Health Science Reports

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Background: Robotic gastrectomy is a commonly used procedure for early gastric cancer and it also overcomes the limitation of laparoscopic. However, the complications of robotic gastrectomy (RG) still need to be assessed. Our study was designed to compare postoperative complications of RG with laparoscopic gastrectomy (LG). Materials and Methods:A meta-analysis and systemic review were prospectively collected using the PubMed, Cochrane Library, and MEDLINE database of published studies by comparing the RG and LG with gastric cancer up to December 2021. To evaluate the postoperative outcomes, odds ratios were calculated for Dichotomous data and the mean difference with 95% confidence interval (CI) was calculated for continuous data, and measured by the random-effect model.Results: Thirty-two retrospective studies describing 13,585 patients (4484 RG and 9101 LG) satisfied the inclusion criteria. A statistically significant result was in blood loss (MD = −17.97, 95% Cl: −25.61 to 10.32, p < 0.001), Clavien−Dindo grade Ⅲ (odds ratio (OR) = 0.60, 95% CI: 0.48−0.76, p < 0.01), and harvested lymph node (MD = 2.62, 95% CI: 2.14−3.11, p < 0.001). There was no significant difference between robotic gastrectomy surgery (RGS) and laparoscopic gastrectomy surgery (LGS) regarding distal resection margin (DRM), proximal resection margin (PRM), conversion rate, anastomotic leakage, and overall complications. Conclusion:Having significant outcomes in Clavien-Dindo grade III, and blood loss, harvested lymph nodes are more common in RGS, and they also help in increasing the quality of life.

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A meta-analysis of robotic gastrectomy versus open gastrectomy in gastric cancer treatment

Cited by 8 publications

References 22 publications

Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

Postoperative outcomes in robotic gastric resection compared with laparoscopic gastric resection in gastric cancer: A meta‐analysis and systemic review

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