Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Abstract

Reports in the field of robotic surgery for gastric cancer are increasing. However, studies only on patients with advanced gastric cancer (AGC) are lacking. This retrospective study was to compare the short-term outcomes of robotic-assisted distal gastrectomy (RADG) and laparoscopic-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for AGC. From December 2014 to November 2019, 683 consecutive patients with AGC underwent mini-invasive assisted distal gastrectomy. Propensityscore matching (PSM) analysis was conducted to reduce patient selection bias. Short-term outcomes were compared between the two groups. The clinical features were well matched in the PSM cohort. Compared with the LADG group, the RADG group was associated with less operative blood loss, a lower rate of postoperative blood transfusion, less volume of abdominal drainage, less time to remove abdominal drainage tube, retrieved more lymph node, and lower rates of surgical complications and pancreatic fistula (P <0.05). However, the time to recovery bowel function, the length of postoperative stay, the rates of other subgroups of complications and unplanned readmission were similar between the two groups (P > 0.05). This study suggests that RADG is a safe and feasible technique with better short-term outcomes than LADG for AGC.Gastric cancer continues to be a major public health problem worldwide, especially in developing countries, such as China 1,2 . Every year, approximately 680,000 new patients are diagnosed with gastric cancer in China; among them, more than 80% of these patients have advanced-stage disease 1,3 . For patients with advanced gastric cancer (AGC), multidisciplinary comprehensive treatment is usually required, and gastrectomy with lymph node dissection is currently considered to be the only curable treatment 4 .In the past few decades, with the development of science and technology, much advanced surgical equipment has been invented, particularly in the field of mini-invasive surgery (MIS). Since laparoscopy-assisted Billroth I gastrectomy was first reported in 1994, several randomized controlled trials (RCTs) have demonstrated that laparoscopic gastrectomy (LG) for AGC is a safe and feasible technique with better short-term outcomes than and similar oncological outcomes to open gastrectomy [5][6][7][8][9] . Although LG has obtained greater acceptance among abdominal surgeons, because of the limitations of laparoscopic instruments, it is difficult to perform precisely, as is the case with D2 lymphadenectomy 10,11 .Robotic surgery systems, as another MIS method, were invented to overcome the drawbacks of laparoscopy and are becoming increasingly accepted by abdominal surgeons. Since Hashizume et al. first reported the use of robotic surgery for gastric cancer in 2002, a number of studies have shown the safety and advantages of robotic

Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis

“…After removing 66 duplicates, 246 studies excluded by carefully reading the titles and abstracts because it was a review, letter, conference report, comment, case report, or animal experimental study. One hundred eighteen potential articles were thoroughly evaluated through fulltext articles, and finally, a total of 19 retrospective studies were included in the final meta-analysis according to inclusion and exclusion criteria [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. A flow diagram of the search strategies, which includes reasons for the exclusion of studies, is shown in Fig.…”

Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis

“…A total of 430 potential articles,which were published before May 2020,were retrieved from our databases.After removing 66 duplicates,246 studies excluded by carefully reading the titles and abstracts because it was a review,letter,conference report,comment,case report or animal experimental study.118 potential articles were thoroughly evaluated through full text articles,and nally,a total of 19 retrospective studies were included in the nal meta-analysis according to inclusion and exclusion criteria [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].A ow diagram of the search strategies,which includes reasons for the exclusion of studies, is shown in Fig. 1.…”

“…19 studies with a total of 7275 patients, of which 4598 patients were in the LG group and 2677 in the RG group,were involved.14 of the included studies were published in English [22][23][24][25][26][27][28][29][32][33][34][35][36][37],and 5 published in Chinese [20,21,30,31,38].Among the 19 studies,13 were from China [20-23, 28, 30-32, 34-38],4 from Korea [24][25][26]29] and 2 from Japan [27,33]. The basic characteristics of the included studies are listed in Table 1.The evaluation of quality according to the NOS is shown in Table 2.…”

<p>Effects of miR-384 and miR-134-5p Acting on YY1 Signaling Transduction on Biological Function of Gastric Cancer Cells</p>

“…1,2 Although recent years have witnessed the significant decline in mortality of GC, the number of patients diagnosed each year increases constantly due to population growth. 3 What is notable is that the lack of suitable screening and treatment biomarkers has resulted in dreadful survival rate of GC patients. Therefore, the call for investigation in the mechanisms underlying the onset and progression of GC is pressing.…”