Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

Abstract

AIMTo investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODSThis is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTSThe present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups.CONCLUSIONLaparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Robotic vs open gastrectomy for gastric cancer: A propensity score‐matched analysis on short‐ and long‐term outcomes

“…Several authors found that length of hospital stay was shorter after RG with a mean pooled advantage of 3 days . In our analysis, we could not find such a difference neither in the whole sample nor in the matched cohort.…”

“…However, RG was associated with longer operative times. This finding has also been confirmed by other comparative studies . In our opinion, docking time and learning curve might have had played a role in increasing operative time.…”

“…In the present paper postoperative complication rate was around 30% while it was 5% for major postoperative complications (Clavien‐Dindo > 2). In literature, the postoperative morbidity rate for RG has been reported to range between 0% and 61% . The majority of comparative studies found RG as a safe procedure with postoperative morbidity/mortality rates comparable with those of standard OG .…”

“…A few studies tried to verify the safety and efficacy of RG comparing this procedure with the LG or open gastrectomy (OG) . Most of these studies were characterized by limited sample size, and thus, their results have been difficult to interpret.…”

Survey of nutritional practices in total gastrectomy and oesophagectomy procedures

“…However, this is indicative of the lower frequency of such procedures in Australian and New Zealand hospitals compared to hospitals servicing larger populations in USA and Europe. Another key consideration is the rising use of minimally invasive surgical techniques in oesophageal and gastric cancer surgery, which reduce the duration of hospital stay and may impact patient postoperative nutritional requirements …”