A Comparative Analysis Of Robotic Versus Laparoscopic Gastrectomy For Gastric Cancer

Part 1. A descriptive analysis of robotic versus laparoscopic gastrectomy for gastric cancerObjective:We analyzed an updated clinical trials that have compared robot-assisted gastrectomy (RAG) with laparoscopy-assisted gastrectomy (LAG) to evaluate whether RAG is equivalent to LAG.Methods:A literature search was performed in PubMed, Embase, and Web of Science databases for clinical research published that compared RAG with LAG. Complications, harvested lymph nodes, proximal margin, distal margin, hospital stay, operative time, and estimated blood loss were compared using odds ratios and weighted mean differences (WMDs).Results:Eight studies were included in the analysis, comprising 1875 patients (506 RAGs,1369 LAGs). RAG was associated with a longer operative time (WMD 48.46 min; 95% confidence interval (CI) 29.49-67.43;p< 0.05), lower estimated blood loss (WMD-38.43 ml; 95% CI-67.55 to-9.30; p< 0.05), and a longer distal margin (WMD 1.04 cm; 95% CI0.46-1.62; p<0.05). Complications, hospital stay, proximal margin, and harvested lymph nodes for RAG and LAG were similar.Conclusions:RAG can be performed safely with lower estimated blood loss and a longer distal margin than with LAG. RAG is as acceptable as LAG for obtaining a safe surgical margin and for performing radical lymph node dissection. Radical resection can be achieved by RAG. With acceptable complications and radical resection, RAG is a promising approach when compared with LAG.Part 2. Robotic versus laparoscopic gastrectomy for gastric cancer:comparison of short-term surgical outcomesObjective:This study was designed to compare RAG with LAG in short-term surgical outcomes in our hospital.Methods:Between October 2011 and August 2014,423 patients underwent robotic or laparoscopic gastrectomy:93 RAG and 330 LAG. We performed a comparative analysis between RAG group and LAG group for clinicopathological characteristics and short-term surgical outcomes.Results:RAG was associated with a longer operative time (P< 0.001), lower blood loss (P= 0.001) and more harvested lymph nodes (P= 0.047). Only 3 patients in LAG group had positive margins, and R0 resection rate for RAG and LAG were similar (P= 0.823). The RAG group had postoperative complications of 9.8%, comparable with those of the LAG group (P= 0.927). Proximal margin, distal margin, hospital stay, days of first flatus and days of eating liquid diet for RAG and LAG were similar. In the subgroup of early-stage gastric cancer, RAG had a longer operation time (P= 0.008), less intraoperative blood loss (P= 0.037) and more harvested lymph nodes (P= 0.041). However, in the subgroup of advanced gastric cancer, RAG had a longer operation time (P= 0.045), but no less intraoperative blood loss (P= 0.754) and no more harvested lymph nodes (P= 0.424).Conclusions:The comparative study demonstrates that RAG is as acceptable as LAG in terms of surgical and oncologic outcomes. With more harvested lymph nodes, lower estimated blood loss, acceptable complications and radical resection, RAG is a promising approach for the treatment of gastric cancer. However, the indication of patients for RAG is critical. Now, RAG was more suitable for early-stage gastric cancer.