Robotic Gastrectomy Compared with Laparoscopic Gastrectomy for Clinical Stage I/II Gastric Cancer Patients: A Propensity Score‐Matched Analysis

Abstract

Background Robotic gastrectomy (RG) has been developed to address the drawbacks of laparoscopic gastrectomy (LG); however, whether or not RG is superior to conventional LG remains to be seen. The present study aimed to clarify the impact of RG on clinical stage I/II gastric cancer patients. Methods The present study included 1208 patients with clinical stage I/II gastric cancer who had minimally invasive gastrectomy from January 2012 to March 2020 at the Shizuoka Cancer Center. The short-and long-term outcomes of RG and LG were compared after propensity score matching. Results This study involved 835 LG and 345 RG patients. After propensity score matching, there were 342 patients each in the RG and LG groups, with an improved balance of confounding factors between the two groups. RG was associated with a significantly longer operative time and lower amylase concentration in the drainage fluid on the first postoperative day than LG. Furthermore, the incidence of intra-abdominal infectious complications in the RG was lower than that in the LG (4.4% vs. 9.4%; P = 0.015). The survival of the RG and LG groups was equivalent. Conclusions RG reduced the risk of intra-abdominal infectious complications in comparison with LG in the propensity score-matched analysis. Patients treated by the two approaches showed equivalent survival.

Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer

“…The currently two available randomized trials upon the argument, as already mentioned, support an advantage of RG over LG on lymphadenectomy [23,24]. Other observational reports and several recent meta-analyses echo such findings [8,13,14,25,30], also in obese patients. Choi et al recently published a study that compared short and long terms outcomes of open, laparoscopic, and robotic radical gastrectomy with D2 lymphadenectomy in obese patients.…”

“…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.…”

“…This finding may reflect the greater mean number of retrieved lymph nodes that seems to be associated with the robotic approach [6,8,13,14,[23][24][25]30]. Three-dimensional video system, wrist movements, the stable traction of the robotic instruments as well as ICG fluorescent lymphography may explain the superior lymphadenectomy performance associated with RG [43].…”

“…Minimally Invasive Gastrectomy (MIG) is now almost universally accepted as a valid option for the treatment of gastric cancer (GC) as it optimizes postoperative recovery without compromising the adequacy of resection and long-term oncological outcomes [1][2][3][4][5][6]. Recent NCCN guidelines (version 2.2021) for GC treatment indicate that MIG (including both conventional laparoscopic and robotic techniques) may be considered, for early and locally advanced cases, provided specific expertise in minimally invasive foregut procedures and lymphadenectomy are available [1][2][3][5][6][7][8][9].…”

“…The technical difficulties of laparoscopic surgery that are encountered in performing MIG have led some surgical teams to the use of robotic surgery [10,11]. Indeed, robotics has been originally introduced in clinical practice to overcome some of the intrinsic limitations of conventional laparoscopic and to broaden the range of application of minimally invasive surgery, and also in the field of the surgery of the stomach, several experiences have indicated excellent outcomes [3,[5][6][7][8][9]. A recent study by Stewart et al have investigated the adoption of robotic surgery in surgical oncology by analyzing the available data from the National Inpatient Sample (NIS) American database [12].…”