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

Abstract

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.

Risk Assessment and Preventive Treatment for Peritoneal Recurrence Following Radical Resection for Gastric Cancer

“…Compared with laparoscopic surgery, robotic surgery, another MIS, has prominent advantages, such as fatigue reduction, high stability, and three-dimensional vision, and has been gradually applied in the treatment of GC. In addition, many studies have also reported better minimally invasive advantages with robotic surgery than laparoscopic surgery in radical gastrectomy, and these two operative methods have similar short-and long-term outcomes as well as postoperative peritoneal recurrence rates (49)(50)(51)(52)(53). Regarding the high expense of robotic surgery, its application in the treatment of GC is still not yet popularized.…”

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

“…Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes [8][9][10][11]. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment [8][9][10][11].…”

“…Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes [8][9][10][11]. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment [8][9][10][11]. Despite the strong interest, LG has been witnessing a rather rare use, due to poor evidence of long-term survival outcomes and concerns about oncological relevance of surgical resection [8][9][10][11].…”

“…In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment [8][9][10][11]. Despite the strong interest, LG has been witnessing a rather rare use, due to poor evidence of long-term survival outcomes and concerns about oncological relevance of surgical resection [8][9][10][11]. Outcomes of robust trials proved the oncological safety of LG compared with open gastrectomy (OG) by showing non-inferiority in survival [8][9][10][11].…”

“…Despite the strong interest, LG has been witnessing a rather rare use, due to poor evidence of long-term survival outcomes and concerns about oncological relevance of surgical resection [8][9][10][11]. Outcomes of robust trials proved the oncological safety of LG compared with open gastrectomy (OG) by showing non-inferiority in survival [8][9][10][11]. Moreover, technical problems related to total gastrectomy as well as D2 lymphadenectomy prevent the diffusion of laparoscopic surgery, as D2 lymphadenectomy entails the removal of node stations along celiac trunk, left gastric artery and hepatic pedicle [8].…”