Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study

Abstract

Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14 ± 59.18 vs. 270.34 ± 52.22 min, p = 0.003), less intraoperative bleeding (154.37 ± 89.68 vs. 183.77 ± 95.39 ml, p = 0.004) and more N2 tier RLNs (9.07 ± 5.34 vs. 7.56 ± 4.50, p = 0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90 ± 13.05 vs. 31.91 ± 12.46, p = 0.065). Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p = 0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55 and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p = 0.145), and the ratio of splenectomy were 1.59 and 0.39% (p = 0.253). The mortality rates were 0.8 and 0.4% for the RATG and LATG groups, respectively (p = 1.000). Conclusion: This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

Can a single-port robot be safely used for robotic total gastrectomy for advanced gastric cancer? First experience using the da Vinci SP platform

“…For patients with advanced gastric cancer, Yang et al . also found that the blood loss of the RTG group was significantly lower than that of the LTG group (154.37 ± 89.68 vs 183.77 ± 95.39 mL, P = 0.004) [ 32 ]. The estimated blood loss in our case was 225 mL, which is more than that of RTG reported previously but to an acceptable extent.…”

Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients

“…This finding could be attributed to the advanced robotic surgery systems, including an internal EndoWrist with seven degrees of freedom, three-dimensional vision, tremor filter, and short learning curve, which prevented injuries from the blood vessels and allowed precise dissection and high flexibility for surgeons [ 32 ]. Previous studies proved that one critical barrier to the wide RG application in clinical practice was high costs [ 12 , 13 , 16 , 17 , 33 , 34 ]. Our study also found that RADG group had higher medical cost than the LADG group.…”

“…Although several studies have reported the postoperative complications, the results are still elusive [ 16 , 38 – 40 ]. A previous study demonstrated that RG showed similar postoperative morbidity to that of LG [ 16 ]. A recent meta-analysis also revealed no significant differences in the overall or severe complication rates between robotic and laparoscopic groups [ 30 ].…”

Early experience with total robotic D2 gastrectomy in a low incidence region: surgical perspectives

“…The oncological short-term safety of robotic gastrectomy is reported comparable to open and probably laparoscopic resection [ 4 – 6 , 16 ]. A recent randomized controlled trial of robotic versus laparoscopic gastrectomy showed improved lymphadenectomy by the robotic approach for extraperigastric lymph nodes including station 12a.…”

“…Evidence from a wide range of series, most Asian, indicates that minimally invasive robotic gastrectomy may also be performed with short-term oncologic outcome comparable to that of open surgery [ 2 , 3 ]. Available reports include series of robotic assisted and total robotic surgery for distal and total gastrectomy [ 4 – 6 ]. A recent randomized controlled trial reported benefits of robotic compared to laparoscopic distal gastrectomy in regard to morbidity, recovery, and lymphadenectomy [ 7 ].…”