Robotic versus laparoscopic gastrectomy for gastric cancer: protocol for umbrella review of systematic reviews and meta-analyses

Marano, Luigi; Fusario, Daniele; Savelli, Vinno; Verre, Luigi; Neri, Alessandro; Marrelli, Daniele; Roviello, Franco

doi:10.1136/bmjopen-2019-033634

Cited by 5 publications

(4 citation statements)

References 26 publications

(26 reference statements)

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“…The protocol has been registered with PROSPERO (no. CRD42019139906) and has been published [ 27 ]. The review was performed following the protocol without deviation.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The “related article” function from PubMed will be used to further identify potential articles that were eligible for inclusion in the review. The bibliography of all selected articles will be hand searched to identify additional articles that met our inclusion criteria [ 27 ].…”

Section: Methods and Analysismentioning

confidence: 99%

“…Since several previous systematic reviews on the comparison of RG and LG are available and timely evidence is required to inform the scientific community, we believed a de novo systematic review was inappropriate, and, as reported in our published protocol [ 27 ], we performed a comprehensive umbrella review to collect and assess information from previous systematic reviews that have compared the laparoscopic with robotic gastrectomy.…”

Section: Introductionmentioning

confidence: 99%

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Robotic versus laparoscopic gastrectomy for gastric cancer: an umbrella review of systematic reviews and meta-analyses

et al. 2021

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An umbrella review was performed to summarize literature data and to investigate benefits and harm of robotic gastrectomy (RG) compared to laparoscopic (LG) approach. To overcome the intrinsic limitations of laparoscopy, the robotic approach is claimed to facilitate lymph-node dissection and complex reconstruction after gastrectomy, to assure oncologic safety also in advanced gastric cancer. A literature search was conducted in PubMed, Cochrane and Embase databases for all meta-analyses published up to December 2019. The search strategy was previously published in a protocol. We selected fourteen meta-analyses comparing outcomes between LG and RG with curative intent in patients with diagnosis of resectable gastric cancer. We highlight that RG has a longer operation time, inferior blood loss, reduction in hospital stay and a more rapid recovery of bowel function. In meta-analyses with statistical significance the number of nodes removed in RG is higher than LG and the distal margin of resection is higher. There is no difference in terms of total complication rate, mortality, morbidity, anastomotic leakage, anastomotic stenosis, intestinal obstruction and in conversion rate to open technique. The safety and efficacy of robotic gastrectomy are not clearly supported by strong evidence, suggesting that the outcomes reported for each surgical technique need to be interpreted with caution, in particular for the meta-analyses in which the heterogeneity is large. Certainly, robotic gastrectomy is associated with shorter time to oral intake, lesser intraoperative bleeding and longer operation time with an acceptable level of evidence. On the other hand, the data regarding other outcomes are insufficient as well as non-significant, from an evidence point of view, to draw any robust conclusion.

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“…The protocol has been registered with PROSPERO (no. CRD42019139906) and has been published [ 27 ]. The review was performed following the protocol without deviation.…”

Section: Methods and Analysismentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Robotic versus laparoscopic gastrectomy for gastric cancer: an umbrella review of systematic reviews and meta-analyses

et al. 2021

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“…Intracorporeal mechanically stapled Roux‐en‐Y anastomosis is a key step and challenge in the process of digestive tract reconstruction, particularly in patients with obesity 24 . Few studies exist on whether the robotic surgery system has technical advantages or whether it can improve the surgical results and long‐term survival of total gastrectomy patients, 20–22 and controversy regarding which gastric cancer method is superior may exist, some umbrella reviews or metanalyses of metanalyses have shown that the safety and effectiveness of robotic gastrectomy still need strong evidence to prove that a larger sample size and clinical trials are needed to support the advantages of robotic surgery 25–27 . We performed the first DaVinci robotic surgical system‐assisted radical gastrectomy on October 14, 2014, and have since performed more than 1000 of these procedures.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative performance and outcomes of robotic and laparoscopic total gastrectomy for gastric cancer: A high‐volume center retrospective propensity score matching study

et al. 2023

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Background Studies on robotic total gastrectomy (RTG) are currently limited. This study aimed to compare the intraoperative performance as well as short‐ and long‐term outcomes of RTG and laparoscopic total gastrectomy (LTG). Methods A total of 969 patients underwent robotic (n = 161) or laparoscopic (n = 636) total gastrectomy between October 2014 and October 2021. The two groups of patients were matched 1:3 using the propensity score matching (PSM) method. The intraoperative performance as well as short‐ and long‐term outcomes of the robotic (n = 147) and the laparoscopic (n = 371) groups were compared. Results After matching, the estimated intraoperative blood loss was lower (80.51 ± 68.77 vs. 89.89 ± 66.12, p = 0.008), and the total number of lymph node dissections was higher (34.74 ± 12.44 vs. 29.83 ± 12.22, p < 0.001) in the RTG group compared with the LTG group. More lymph node dissections at the upper edge of the pancreas were performed in the RTG group than in the LTG (12.59 ± 4.18 vs. 10.33 ± 4.58, p = 0.001). Additionally, postoperative recovery indicators and laboratory data were greater in the RTG group than those in the LTG group, while postoperative complications were comparable between the two groups (19.0% vs. 18.9%, p = 0.962). For overweight or obese patients with body mass indexes (BMIs) ≥25, certain clinical outcomes of the RTG remained advantageous, and no significant differences in three‐year overall survival (OS) or relapse‐free survival (RFS) were observed. Conclusions Robotic total gastrectomy demonstrated better intraoperative performance, could improve the short‐term clinical outcomes of patients, and was more conducive to patient recovery. However, the long‐term efficacies of the two approaches were similar. Robotic surgical systems may reduce surgical stress responses in patients, allowing them to receive postoperative chemotherapy sooner.

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Current status of robotic gastrectomy for gastric cancer: comparison with laparoscopic gastrectomy

Kim

Hyung

2021

Updates Surg

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Robotic versus laparoscopic gastrectomy for gastric cancer: protocol for umbrella review of systematic reviews and meta-analyses

Cited by 5 publications

References 26 publications

Robotic versus laparoscopic gastrectomy for gastric cancer: an umbrella review of systematic reviews and meta-analyses

Robotic versus laparoscopic gastrectomy for gastric cancer: an umbrella review of systematic reviews and meta-analyses

Intraoperative performance and outcomes of robotic and laparoscopic total gastrectomy for gastric cancer: A high‐volume center retrospective propensity score matching study

Current status of robotic gastrectomy for gastric cancer: comparison with laparoscopic gastrectomy

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