Propensity Score-Matched Analysis of the Short- and Long-Term Outcomes of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer

Nishi, Masaaki; Shimada, Mistuo; Yoshikawa, Kozo; Takasu, Chie; Wada, Yuma; Tokunaga, Takuya; Nakao, Toshihiro; Kashihara, Hideya; Yoshimoto, Toshiaki; Yamashita, Shoko

doi:10.1245/s10434-021-11203-7

Cited by 13 publications

(17 citation statements)

References 29 publications

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“…Nishi's study, which recruited 451 patients undergoing minimally invasive surgery, showed that RG caused significantly less operative blood loss than LG [15]. In the current study, the operative blood loss was less in RADG group than in LADG group.…”

Section: Discussionsupporting

confidence: 43%

“…In addition, a retrospective multicenter study covering 3552 patients with GC showed that the morbidity rates were 12.6% in RG group and 15.2% in LG group, with a significant difference [18]. Moreover, previous single-center studies [14,15,27,40] and a meta-analysis [41] have reported that the RG complication rate varied from 5.2 to 24.1%. In our study, the postoperative complication rate of RADG group was comparable to that of LADG group (13.7% vs. 16.6%, P = 0.242).…”

Section: Discussionmentioning

confidence: 96%

“…Additionally, a robotic surgical system has been introduced to address the limitations of laparoscopy and is welcomed in GC treatment owing to its satisfying early postoperative outcomes [13,[15][16][17]. Robotic gastrectomy (RG) has been confirmed to be a safe and feasible technique with better anatomical and operative conditions and comparable long-term results compared to LG [12,15,[18][19][20]. However, most studies were limited to short-term outcomes, unmatched groups, small sample sizes, and early GC.…”

Section: Introductionmentioning

confidence: 99%

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Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients

et al. 2022

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Background Studies on surgical outcomes after robotic surgery are increasing; however, long-term oncological results of studies comparing robotic-assisted distal gastrectomy (RADG) versus laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC) are still limited. This study aimed to assess the surgical and oncological outcomes of RADG and LADG for the treatment of AGC. Methods A total of 1164 consecutive AGC patients undergoing RADG or LADG were enrolled between January 2015 and October 2021. Propensity score-matched (PSM) analysis was performed to minimize selection bias. The perioperative and oncological outcomes between the two groups were compared. Results Patient’s characteristics were comparable between the two groups after PSM. RADG group represented a longer operative time (205.2 ± 43.1 vs 185.3 ± 42.8 min, P < 0.001), less operative blood loss (139.3 ± 97.8 vs 167.3 ± 134.2 ml, P < 0.001), greater retrieved lymph nodes (LNs) number (31.4 ± 12.1 vs 29.4 ± 12.3, P = 0.015), more retrieved LNs in the supra-pancreatic areas (13.4 ± 5.0 vs 11.4 ± 5.1, P < 0.001), and higher medical costs (13,608 ± 4326 vs 10,925 ± US $3925, P < 0.001) than LADG group. The overall complication rate was 13.7% in the RADG group and 16.6% in the LADG group, respectively; the difference was not significantly different (P = 0.242). In the subgroup analysis, the benefits of RADG were more evident in high BMI patients. Moreover, the 3-year overall survival (75.5% vs 73.1%, P = 0.471) and 3-year disease-free survival (72.9% vs 71.4%, P = 0.763) were similar between the two groups. Conclusion RADG appears to be a safe and feasible procedure and could serve as an alternative treatment for AGC in experienced centers.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients

et al. 2022

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“…A total of 11 retrospective matched-cohort studies have reported 3-or 5-year DFS rates between RG and LG (eTable 5, Supplemental Digital Content 1, http://links.lww. com/SLA/F3), 15,19,[27][28][29][30][31][32][33][34][35] with the majority indicating a slightly better survival by RG. Yet, the majority of these studies were constrained by their single-center methodologies and limited sample sizes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Short-term and Three-year Oncological Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer

Lu,

Li,

Zhang

et al. 2024

Annals of Surgery

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Objective: To compare the short- and long-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. Summary Background Data: The clinical outcomes of RG over LG have not yet been effectively demonstrated. Methods: This retrospective cohort study included 3,599 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals in China from August 2016 to June 2019. Propensity score matching (PSM) was performed between patients who received RG and LG. The primary endpoint was 3-year disease-free survival (DFS). Results: After 1:1 PSM, 1034 pairs of patients were enrolled in a balanced cohort for further analysis. The 3-year DFS in the RG and LG was 83.7% and 83.1% (P=0.745), respectively, and the 3-year overall survival (OS) was 85.2% and 84.4%, respectively (P=0.647). During three years of follow-up, 154 patients in the RG and LG groups relapsed (cumulative incidence of recurrence: 15.0% vs. 15.0%, P=0.988). There was no significant difference in the recurrence sites between the two groups (all P>0.05). Sensitivity analysis showed that RG had comparable 3-year DFS (77.4% vs. 76.7%, P=0.745) and OS (79.7% vs. 78.4%, P=0.577) to LG in patients with advanced (pathological T2-4a) disease, and the recurrence pattern within three years was also similar between the two groups (all P>0.05). RG had less intraoperative blood loss, lower conversion rate, and shorter hospital stays than LG (all P>0.05). Conclusions: For resectable gastric cancer, including advanced cases, RG is a safe approach with comparable 3-year oncological outcomes to LG when performed by experienced surgeons.

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“…We previously reported the short-term superiority of RS over LS for gastric cancer. 13 One prospective randomized controlled trial compared the short-term e cacy of robotic versus laparoscopic distal gastrectomy and showed that RS achieved a lower morbidity rate, faster recovery, a milder in ammatory response, and improved lymphadenectomy. 6 However, the utility of RS for Siewert II/III AEG remains controversial because of the lack of scienti c evidence.…”

Section: Discussionmentioning

confidence: 99%

Utility of robotic surgery for Siewert type II/III adenocarcinoma of esophagogastric junction: transhiatal robotic versus laparoscopic approach

Nishi

Wada

Yoshikawa

et al. 2023

Preprint

Self Cite

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Background Robotic surgery (RS) has been rapidly adopted for gastric cancer and adenocarcinoma of the esophagogastric junction (AEG). However, the utility of RS for Siewert type II/III AEG remains unclear. Methods Forty-one patients who underwent either transhiatal RS (n = 15) or laparoscopic surgery (LS) (n = 26) for Siewert type II/III AEG were enrolled in this study. The surgical outcomes of the two groups were compared. Results In the entire cohort, there were no significant intergroup differences in the operative time, blood loss volume, or number of retrieved lymph nodes. The length of the postoperative hospital stay was shorter in the RS group than in the LS group (14.20 ± 7.10 days vs. 18.73 ± 17.82 days, respectively; p = 0.0388). The morbidity rate (Clavien–Dindo grade ≥ 2) was similar between the groups. In the Siewert II cohort, there were no significant intergroup differences in short-term outcomes. In the entire cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (91.67% vs. 91.48%, N.S.) or 3-year disease-free survival rate (91.67% vs. 91.78%, N.S.), respectively. Likewise, in the Siewert type II cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (80.00% vs. 93.33%, N.S.) or 3-year disease-free survival rate (80.00% vs. 94.12%, N.S.), respectively. Conclusions Transhiatal RS for Siewert II/III AEG was safe and contributed to similar short-term and long-term outcomes compared with LS.

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Propensity Score-Matched Analysis of the Short- and Long-Term Outcomes of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer

Cited by 13 publications

References 29 publications

Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients

Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients

Comparison of Short-term and Three-year Oncological Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer

Utility of robotic surgery for Siewert type II/III adenocarcinoma of esophagogastric junction: transhiatal robotic versus laparoscopic approach

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