Feasibility of Linear-Shaped Gastroduodenostomy during the Performance of Totally Robotic Distal Gastrectomy

Abstract

Purpose: Although linear-shaped gastroduodenostomy (LSGD) was reported to be a feasible and reliable method of Billroth I anastomosis in patients undergoing totally laparoscopic distal gastrectomy (TLDG), the feasibility of LSGD for patients undergoing totally robotic distal gastrectomy (TRDG) has not been determined. This study compared the feasibility of LSGD in patients undergoing TRDG and TLDG. Materials and Methods: All c: onsecutive patients who underwent LSGD after distal gastrectomy for gastric cancer between January 2009 and December 2017 were analyzed retrospectively. Propensity score matching (PSM) analysis was performed to reduce the selection bias between TRDG and TLDG. Short-term outcomes, functional outcomes, learning curve, and risk factors for postoperative complications were analyzed. Results: This analysis included 414 patients, of whom 275 underwent laparoscopy and 139 underwent robotic surgery. PSM analysis showed that operation time was significantly longer (163.5 vs. 132.1 minutes, P<0.001) and postoperative hospital stay significantly shorter (6.2 vs. 7.5 days, P<0.003) in patients who underwent TRDG than in patients who underwent TLDG. Operation time was the independent risk factor for LSGD after intracorporeal gastroduodenostomy. Cumulative sum analysis showed no definitive turning point in the TRDG learning curve. Long-term endoscopic findings revealed similar results in the two groups, but bile reflux at 5 years showed significantly better improvement in the TLDG group than in the TRDG group (P=0.016). Conclusions: LSGD is feasible in TRDG, with short-term and long-term outcomes comparable to that in TLDG. LSGD may be a good option for intracorporeal Billroth I anastomosis in patients undergoing TRDG.

Comparison of short-term outcomes and quality of life in totally laparoscopic distal gastrectomy and totally robotic distal gastrectomy for clinical stage I–III gastric cancer: study protocol for a multi-institutional randomised clinical trial

“…For RDG, Lu’s RCT study showed that patients in the RDG group reduced postoperative morbidity compared with LDG group (9.2% vs 17.6%, p=0.039). 12 As the incidence rates in the TRDG group range from 4.7% to 15.9% in retrospective studies 16 31 32 and given the proficiency of surgeons who perform robotic gastrectomy and the reasonable cost-effectiveness of robotic surgery, 9.0% is the expected 30-day postoperative morbidity in the TRDG group in this study. PASS V.15.0 software was used to calculate sample sizes of 307 with a 1:1 ratio in each group, achieving 80% power to detect a difference between the group proportions of 7.5%.…”

“…At present, the safety and feasibility of TLDG and TRDG has been proven. 16 However, no prospective study has compared short-term outcomes and quality of life (QOL) for TLDG and TRDG with intracorporeal anastomosis for clinical stage I–III patients to our knowledge. To evaluate how different surgical approaches affect short-term outcomes and QOL for patients with gastric cancer, it is necessary to carry out this multi-institutional randomised controlled trial.…”