Pooled analysis of the oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer

Abstract

Aim: Robotic gastrectomy (RG) is more and more widely used in the treatment of gastric cancer. However, the long-term oncological outcomes of RG have not been well evaluated. The aim of this study was to evaluate the long-term oncological outcomes of RG and laparoscopic gastrectomy (LG) in the treatment of gastric cancer. Materials and Methods: PubMed, China National Knowledge Infrastructure, Cochrane Library and EMBASE electronic databases were searched until August 2019. Eligible studies were analysed for comparison of oncological outcomes between RG and LG in patients with gastric cancer. Results: Eleven retrospective comparative studies, which included 1347 (32.52%) patients in the RG group and 2795 (67.48%) patients in the LG group, were selected for the analysis. Meta-analysis of the 11 included studies showed that there was no statistically significant difference in the OS between the RG and LG groups (hazard ratios [HRs] = 0.97, 95% confidence intervals [CIs] = 0.80–1.19, P = 0.80). Six studies evaluated disease-free survival (DFS), and pooled analysis showed that there was no statistically significant difference in DFS between RG group and LG group (HR = 0.94, 95% CIs = 0.72–1.23, P = 0.65). According to the odds ratio (OR) analysis, there was no significant difference in 3-year OS, 5-year OS, 3-year DFS and 5-year DFS between the RG and LG groups. Nine articles reported the recurrence rate, and the meta-analysis showed that there was no statistically significant difference between the RG and LG groups (OR = 0.88, 95% CIs = 0.69–1.12, P = 0.31). Conclusions: This meta-analysis indicated that the long-term oncological outcomes in the RG group were similar to that in the LG group.

Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer

“…Published studies comparing RG to LG almost regularly indicate that patients receiving MIG with the robot have reduced perioperative Estimated Blood Loss (EBL). High-level randomized studies mirror this evidence, which is in turn, consistent with recent meta-analyses appraising the issue [ 12 , 17 , 22 ].…”

“…Titles and abstracts were evaluated, and duplicate records were excluded. Full texts with relative bibliographies were thus appraised, and a total of 21 studies were eventually deemed suitable for inclusion and data extraction [ 4 , 5 , 6 , 8 , 13 , 15 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. The selection process is given in Figure 1 , while Table 1 describes the general characteristics of the included studies.…”

“…LG has been published by Yang et al and colleagues and combines the data reported in 11 articles including a total of nearly 4100 patients [17]. Overall, there was a nonsignificant OR of 0.98 and 0.53 favoring RG over LG in terms of 3-year and 5-year OS, respectively.…”

“…Some of reviews have also investigated potential differences between RG and conventional LG, without identifying any significant advantage of one technique over the other [13,14,17]. The latest meta-analysis comparing the oncological outcomes of RG vs.…”

“…However, robotic surgery of the stomach is still in its early stages and its actual role in clinical practice is still to be defined [ 13 , 14 ]. Current evidence essentially indicates non-inferiority of RG to standard Laparoscopic Gastrectomy (LG), but general conclusions on whether RG provides clear advantages over LG are still difficult to draw, as available data is mainly derived from low-level analyses returning highly variable results [ 15 , 16 , 17 , 18 ]. Accordingly, this paper aims to analyze the existing evidence on RG for cancer with special emphasis on comparing the employ of robotic technology to conventional LG.…”