Robotic Verse Laparoscopic Gastrectomy for Gastric Cancer: A Pooled Analysis of 11 Individual Studies

Duan, Bo-Shi; Zhao, Jian; Xie, Longfei; Wang, Yue

doi:10.1097/sle.0000000000000410

Cited by 10 publications

(18 citation statements)

References 28 publications

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“…This was consistent with a previous meta-analysis [40]. Regarding the postoperative complication rate and 30-day mortality rate, the rates were equivalent between the two groups [6][7][8]. Furthermore, the comparable rate of conversion to open surgery also indicated that RG was as safe and effective as LG [6][7][8].…”

Section: Discussionsupporting

confidence: 90%

“…Many studies have demonstrated the safety and feasibility of treating gastric cancer with RG regarding the intraoperative outcomes and short-term outcomes. Some studies indicate that RG and LG are comparable [7][8][9]. However, the data are limited and mostly focus on the prognosis of RG; thus, we conducted an updated meta-analysis to provide a more comprehensive assessment of the two techniques.…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

et al. 2019

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Background Data regarding the long-term oncological outcomes of robotic gastrectomy (RG) are limited despite the increased commonality of this method as an alternative for gastric cancer treatment. Here, we conducted a meta-analysis to evaluate the long-term oncological outcomes of RG in comparison to that of laparoscopic gastrectomy (LG). Methods The PubMed, ISI Web of Science, EMBASE, and Cochrane Library databases were comprehensively searched for studies that compared RG and LG in terms of their long-term survival outcomes. The hazard ratios (HRs) of overall survival (OS), disease-free survival (DFS), and relapse-free survival (RFS) were obtained, while the odds ratio (OR) was recorded for the recurrence rate. A sensitivity analysis was performed. Egger’s test and Begg’s test were applied to evaluate publication bias. Results Eight studies were identified and involved 3410 gastric cancer patients (RG, 1009; LG, 2401). The two groups had no significant differences in OS (HR, 0.98; 95% CI, 0.80–1.20; P = 0.81), DFS (HR, 1.36; 95% CI, 0.33–5.59; P = 0.67), RFS (HR, 0.92; 95% CI, 0.72–1.19; P = 0.53), or recurrence rate (OR, 0.92; 95% CI, 0.71–1.19; P = 0.53). Moreover, the two techniques were comparable in length of hospital stay (LOS), postoperative complication rate, 30-day mortality rate, and rate of conversion to open surgery. Conclusions The long-term oncological outcomes, expressed as OS, DFS, RFS, and recurrence rate, were similar between RG and LG. However, more randomized controlled trials with rigorous study designs and patient cohorts are needed to evaluate the oncologic outcomes of RG in patients with gastric cancer. Electronic supplementary material The online version of this article (10.1186/s12957-019-1628-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

et al. 2019

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“…Table shows the results of the latest meta‐analyses of RG versus LG; the results reflect trends similar to those of the comparative studies featured in Table 1 and indicate higher costs associated with RG . The duration of hospital stay was consistently similar in RG and LG, although there was great variability among comparative studies.…”

Section: Short‐term Outcomes Of Rgsupporting

confidence: 54%

Robotic surgery for the upper gastrointestinal tract: Current status and future perspectives

Nakauchi

Uyama

Suda

et al. 2017

Asian J Endoscop Surgery

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More than 4000 da Vinci Surgical Systems have been installed worldwide. Robotic surgery using the da Vinci Surgical System has been increasingly performed in the last decade, especially in urology and gynecology. The da Vinci Surgical System has not become standard in surgery of the upper gastrointestinal tract because of a lack of clear benefits in comparison with conventional minimally invasive surgery. We initiated robotic gastrectomy and esophagectomy for patients with upper gastrointestinal cancer in 2009, and we have demonstrated the potential advantages of the da Vinci Surgical System in reducing postoperative local complications after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. However, robotic surgery has the disadvantages of a longer operative time and higher costs than the conventional approach. In this review article, we present the current status of robotic surgery for gastric and esophageal cancer, as well as future perspectives on this approach, based on our experience and a review of the literature.

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“…[7][8][9] However, the data comparing robotic surgery to laparoscopic surgery are limited to small numbers and mostly retrospective in nature. 6,10,11 Furthermore, most of the studies comparing the 2 approaches are from East Asia or from high-volume centers. 7,12,13 It is unclear whether these results are applicable to the practices in the United States.…”

Section: Introductionmentioning

confidence: 99%

Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis

et al. 2019

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Background. We compared the outcomes of laparoscopic-assisted (LA) and robotic-assisted (RA) gastrectomies performed for gastric adenocarcinoma in the National Cancer Database. Methods. The National Cancer Database was queried for patients 18 years old with stages I to III gastric adenocarcinoma who underwent LA or RA gastrectomy. Propensity matching was performed between the 2 groups with regard to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results. A cohort of 1893 (1262 = LA, 631 = RA) patients was identified in a 2:1 propensity matching. The groups were well matched. The rate of negative margin as well as 30- and 90-day mortality were similar between the 2 cohorts. Long-term survival was similar between the 2 groups (median survival 49.2 months in LA vs 56.2 months for RA, P = .405). However, the average number of lymph nodes (LNs) sampled was significantly higher in the RA group compared with the LA group (19.6 vs 17.4, P < .001). Similarly, the percentage of surgeries in which ≥15 LNs were sampled was also greater in the RA group compared with the LA group (63.9% vs 57.6%, P = .010). On multivariable analysis, having 15 LNs or more examined was associated with better survival (hazard ratio = 0.72, 95% confidence interval = 0.60-0.87, P < .001). Advanced age, nodal positivity, and advanced clinical stages were significantly associated with worse survival. Conclusions. RA gastrectomy may allow a greater harvest of LNs, and thus more accurate staging, without increasing short-term adverse outcomes compared with LA gastrectomy. Short-term and long-term outcomes in this well-matched cohort appear comparable for both approaches.

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Robotic Verse Laparoscopic Gastrectomy for Gastric Cancer: A Pooled Analysis of 11 Individual Studies

Abstract: RG for the treatment of gastric cancer is a feasible and safe procedure in the hand of experienced laparoscopic surgeons. But the long-term outcomes between the 2 techniques need to be further examined.

Cited by 10 publications

References 28 publications

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

Robotic surgery for the upper gastrointestinal tract: Current status and future perspectives

Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis

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