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

Liao, Guixiang; Zhao, Zhihong; Khan, Muhammad; Yuan, Yawei; Li, Xianming

doi:10.1186/s12957-019-1628-2

Cited by 22 publications

(19 citation statements)

References 42 publications

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“…Because gastric cancer is a malignant tumor,the long-term follow-up oncological outcomes of gastric cancer patients were major concerns of surgeons.OS is a major oncologic outcome.In this meta analysis, the OS was similar to that previously reported [54].The pooled data of the included studies revealed no signi cant difference between the RG and LG groups in OS, RFS, and the recurrence rate without heterogeneity. These results show that the two techniques have similar long-term oncologic outcomes.As far as we know,few metaanalysis had previously reported RFS with RG and LG.The RFS and recurrence rate results further demonstrated the comparability between RG and LG as far as long-term oncological outcomes in this meta analysis.…”

Section: Discussionsupporting

confidence: 86%

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

Zhao

et al. 2020

Preprint

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Background To date, robotic surgery has been widely used worldwide. We conducted a systematic review and meta-analysis to evaluate short- and long-term outcomes of robotic gastrectomy (RG) in gastric cancer patients to determine whether RG can replace laparoscopic gastrectomy (LG).Methods Pubmed, Cochrane Library, WanFang, China National Knowledge Infrastructure (CNKI) and VIP databases were comprehensively searched for studies published before May 2020 that compared RG with LG. Next, two independent reviewers conducted literature screening and data extraction. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS),and the data analyzed using the Review Manager 5.3 software. Random effects or fixed effects models were applied according to heterogeneity.Results A total of 19 studies including 7275 patients were included in the meta-analyses, of which 4598 patients were in the LG group and 2677 in the RG group. Compared with LG,RG was associated with longer operative time (WMD=−32.96 min; 95% CI:-42.08~-23.84, P<0.00001),less blood loss (WMD=28.66 ml; 95% CI: 18.59~38.73, P<0.00001),and shorter time to first flatus (WMD=0.16days; 95%CI:0.06~0.27, P=0.003).There was no significant difference between RG and LG in terms of the hospital stay (WMD=0.23days, 95 % CI:-0.53~0.98, P=0.56),overall postoperative complication (OR=1.07, 95 % CI:0.91~1.25, P=0.43),mortality (OR=0.67, 95% CI=0.24~1.90, P=0.45),the number of harvested lymph nodes (WMD=-0.96, 95% CI:-2.12~0.20, P=0.10),proximal resection margin (WMD=-0.10 cm,95% CI:-0.29~0.09, P=0.30),and distal resection margin (WMD=0.15cm,95% CI:-0.21~0.52, P=0.41).No significant differences were found between the two treatments in overall survival(OS) (HR=0.95, 95% CI:0.76~1.18; P=0.64), recurrence-free survival(RFS) (HR=0.91, 95% CI:0.69~1.21;P=0.53), and recurrence rate (OR=0.90, 95% CI:0.67~1.21; P=0.50). Conclusions The results of this study suggested that RG is as acceptable as LG in terms of short-term and long-term outcomes. RG can be performed as effectively and safely as LG. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of the robotic surgery for gastric cancer.

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Section: Discussionsupporting

confidence: 86%

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

Zhao

et al. 2020

Preprint

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“…OS is a major oncologic outcome. In this meta-analysis, the OS was similar to that previously reported [58]. The pooled data of the included studies revealed no significant difference between the RG and LG groups in OS, RFS, and the recurrence rate without heterogeneity.…”

Section: Discussionsupporting

confidence: 86%

Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis

Ma¹,

Li²,

Zhao³

et al. 2020

World J Surg Onc

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Background To date, robotic surgery has been widely used worldwide. We conducted a systematic review and meta-analysis to evaluate short-term and long-term outcomes of robotic gastrectomy (RG) in gastric cancer patients to determine whether RG can replace laparoscopic gastrectomy (LG). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was applied to perform the study. Pubmed, Cochrane Library, WanFang, China National Knowledge Infrastructure (CNKI), and VIP databases were comprehensively searched for studies published before May 2020 that compared RG with LG. Next, two independent reviewers conducted literature screening and data extraction. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS), and the data analyzed using the Review Manager 5.3 software. Random effects or fixed effects models were applied according to heterogeneity. Results A total of 19 studies including 7275 patients were included in the meta-analyses, of which 4598 patients were in the LG group and 2677 in the RG group. Compared with LG, RG was associated with longer operative time (WMD = −32.96, 95% CI −42.08 ~ −23.84, P < 0.001), less blood loss (WMD = 28.66, 95% CI 18.59 ~ 38.73, P < 0.001), and shorter time to first flatus (WMD = 0.16 95% CI 0.06 ~ 0.27, P = 0.003). There was no significant difference between RG and LG in terms of the hospital stay (WMD = 0.23, 95% CI −0.53 ~ 0.98, P = 0.560), overall postoperative complication (OR = 1.07, 95% CI 0.91 ~ 1.25, P = 0.430), mortality (OR = 0.67, 95% CI 0.24 ~ 1.90, P = 0.450), the number of harvested lymph nodes (WMD = −0.96, 95% CI −2.12 ~ 0.20, P = 0.100), proximal resection margin (WMD = −0.10, 95% CI −0.29 ~ 0.09, P = 0.300), and distal resection margin (WMD = 0.15, 95% CI −0.21 ~ 0.52, P = 0.410). No significant differences were found between the two treatments in overall survival (OS) (HR = 0.95, 95% CI 0.76 ~ 1.18, P = 0.640), recurrence-free survival (RFS) (HR = 0.91, 95% CI 0.69 ~ 1.21, P = 0.530), and recurrence rate (OR = 0.90, 95% CI 0.67 ~ 1.21, P = 0.500). Conclusions The results of this study suggested that RG is as acceptable as LG in terms of short-term and long-term outcomes. RG can be performed as effectively and safely as LG. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of the robotic surgery for gastric cancer.

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“…Finally, regarding the long-term results, the majority of the literature compared robot-assisted surgery and laparoscopy, without differences in terms of disease-free and overall survival [41][42][43]. In our series, as shown by other studies comparing robotic and open gastrectomy, no significant differences were observed in terms of OS and DFS between the two surgical approaches [44].…”

Section: Discussionsupporting

confidence: 49%

Robotic versus open oncological gastric surgery in the elderly: a propensity score-matched analysis

et al. 2020

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Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥ 65 or 75 years is used. Even if robot-assisted surgery is a validated option for the elderly population, there are no specific indications for its application in the surgical treatment of gastric cancer. The aim of this study is to evaluate the safety and feasibility of robot-assisted gastrectomy and to compare the short and long-term outcomes of robot-assisted (RG) versus open gastrectomy (OG). Patients aged ≥ 70 years old undergoing surgery for gastric cancer at the Department of Surgery of San Donato Hospital in Arezzo, between September 2012 and March 2017 were enrolled. A 1:1 propensity score matching was performed according to the following variables: age, Sex, BMI, ASA score, comorbidity, T stage and type of resection performed. 43 OG were matched to 43 RG. The mean operative time was significantly longer in the RG group (273.8 vs. 193.5 min, p < 0.01). No differences were observed in terms of intraoperative blood loss, an average number of lymph nodes removed, mean hospital stay, morbidity and mortality. OG had higher rate of major complications (6.9 vs. 16.3%, OR 2.592, 95% CI 0.623–10.785, p = 0.313) and a significantly higher postoperative pain (0.95 vs. 1.24, p = 0.042). Overall survival (p = 0.263) and disease-free survival (p = 0.474) were comparable between groups. Robotic-assisted surgery for oncological gastrectomy in elderly patients is safe and effective showing non-inferiority comparing to the open technique in terms of perioperative outcomes and overall 5-year survival.

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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

Cited by 22 publications

References 42 publications

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

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

Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis

Robotic versus open oncological gastric surgery in the elderly: a propensity score-matched analysis

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