Robotic versus laparoscopic gastrectomy for gastric cancer in patients with obesity: systematic review and meta-analysis

Abstract

IntroductionThe number of overweight patients with gastric cancer (GC) is increasing, and no previous study has compared laparoscopic gastrectomy (LG) and robotic gastrectomy (RG) in obese patients with GC. To investigate the perioperative and oncologic outcomes of RG and LG in obese GC patients, we performed a meta-analysis of propensity matched scores and retrospective studies to compare the perioperative parameters, oncologic findings, and short-term postoperative outcomes between the two groups.MethodsThis study was performed according to the PRISMA guidelines. A search was performed on PubMed, Web of Science, EMBASE, and Cochrane Central Register to identify eligible propensity matched scores and retrospective studies conducted and published before December 2022. Data on perioperative and oncological outcomes were included in the meta-analysis.ResultsOverall, we identified 1 propensity score match study and 5 randomized control trials of RG and LG, enrolling a total of 718 patients (197 and 521 patients received RG and LG, respectively). No significant differences were observed between the two groups in terms of complications, bleeding, or lymph node dissection. Of note, RG had a longer procedure time (P = 0.03), earlier oral intake (P = 0.0010), shorter hospital stay (P = 0.0002), and shorter time to defecation (P < 0.00001).ConclusionsThis meta-analysis concluded that patients in the RG group had shorter hospital stays, earlier postoperative feeding, and earlier postoperative ventilation; however, no differences were found in blood loss, number of lymph nodes removed, or overall complications. RG is an effective, safe, and promising treatment for obese patients with GC, compensating for the shortcomings of laparoscopy and allowing for less trauma and faster recovery.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022298967.

The Evolving Surgical Landscape: A Comprehensive Review of Robotic Versus Laparoscopic Gastrectomy for the Treatment of Gastric Cancer

“…However, none of the reviewed studies favored the laparoscopic approach over the robotic. Yu et al observed in more detail that the robotic approach was associated with a reduction in the total length of hospital stay by 0.81 days [ 8 ]. Chuan et al concluded a substantial decrease of approximately two days in the length of hospital stay with robotic gastrectomy, from -3.66 to -0.3 days, when compared to laparoscopic gastrectomy [ 14 ].…”

“…The evaluation of time to first flatus in robotic gastrectomy versus laparoscopic gastrectomy revealed a range of findings among the 15 studies that examined it. Overall, nine out of the 15 studies reported a statistically significant decrease in time to the first flatus, in favor of the robotic approach [ 5 , 7 , 8 , 23 , 15 , 26 , 29 , 30 , 34 ]. Notably, Bobo et al [ 7 ] concluded that the time to first postoperative flatus was 0.14 days shorter for the robotic group, with Jin et al [ 29 ] and Yu et al [ 8 ] further backing up this claim (-0,105 and -0.16 days, respectively).…”

“…Overall, nine out of the 15 studies reported a statistically significant decrease in time to the first flatus, in favor of the robotic approach [ 5 , 7 , 8 , 23 , 15 , 26 , 29 , 30 , 34 ]. Notably, Bobo et al [ 7 ] concluded that the time to first postoperative flatus was 0.14 days shorter for the robotic group, with Jin et al [ 29 ] and Yu et al [ 8 ] further backing up this claim (-0,105 and -0.16 days, respectively). However, six studies found no statistically significant differences [ 10 , 22 , 24 , 27 , 31 , 32 ]…”

“…Regarding the time required to initiate oral intake, a clear trend across the eleven studies is evident. Ten studies [ 5 , 8 , 10 , 17 , 24 , 26 , 27 , 30 , 32 , 34 ] concluded that the patients who underwent robotic gastrectomy initiated oral intake earlier than those in the laparoscopic cohorts. Particularly, Guerrini et al reported that the robotic group required 4.25 days to initiate oral intake, while the laparoscopic required 4.45 days [ 24 ].…”

“…Particularly, Guerrini et al reported that the robotic group required 4.25 days to initiate oral intake, while the laparoscopic required 4.45 days [ 24 ]. Overall, the weighted mean difference ranged from -0.13 days [ 30 ] to -0.46 days [ 8 ] in favor of the robotic gastrectomy. Only Cong et al found a non-statistical significant difference [ 31 ].…”