Evaluation Of Clinical Short-term Outcomes Of Da Vinci Robotic Distal Gastrectomy

Objective:Minimally invasive surgery (MIS) with laparoscopy has become widely accepted in the field of gastric cancer. Numerous studies have reported that laparoscopic gastrectomy is beneficial in terms of short-term outcomes, and the long-term outcomes between laparoscopic gastrectomy and open gastrectomy did not differ significantly. However, the laparoscopic approach has some technical limitations that limit complex procedures. These include two-dimensional imaging, restricted range of motion, amplified physiologic tremor, and the surgeon’s postural discomfort. Recently, da Vinci robotic systems have been developed to overcome these drawbacks. Yet, to date only a limited number of studies have focused on robotic surgery in treating gastric cancer, and the role of robotic systems for gastric cancer is still unclear. Thus, we performed a study that has compared robotic assistant distal gastrectomy with Laparoscopic assistant distal gastrectomy for gastric cancer, and aimed to identify the technical feasibility, oncologic safety and short-term outcomes of da Vinci robotic assistant distal gastrectomy.Methods:From February 2012 to May 2014, we retrospectively reviewed the clinicopathological characteristics of 114 patients with diagnosis of gastric cancer in our department.50 patients who experienced robotic gastrectomy and 64 patients who underwent laparoscopic gastrectomy were enrolled in this study. The operation time, estimated blood loss, the number of retrieved lymph nodes and metastatic lymph nodes, postoperative recovery and complications, pathologic characteristics and follow-up results were compared between the groups.Results:There were no significant differences in patient’s demographic characteristics between the two groups. The mean total operation time for robotic group (211.6±37.5 min) was longer than that for laparoscopic group (175.9±27.4 min; P=0.015). The estimated blood loss for robotic group (101.8±68.7 ml) was less than that for laparoscopic group (162.8±91.5 min; P=0.021). The number of retrieved lymph nodes from robotic group (28.7±5.4) were larger than laparoscopic group (21.7±9.6, P= 0.030), as were retrieved metastatic lymph nodes. There were no significant differences in gastrointestinal function recovery time, gastric tube remove time, drainage tube remove time and postoperative hospital stay (P>0.05). Postoperative complications were experienced by 7 patients (14.0%) in the robotic group and 11 patients (17.2%) in the laparoscopic group (P= 0.996). None of the specimens showed microscopic tumor involvement in the resection line. The tumor size, TNM stage and histologic subtypes were similar for the two groups. During a mean follow-up period of 16.1 (range,3～30) months,5 (10.0%)patients experienced relapse and metastasis,4(8.0%)patients died of the disease in robotic group, while 10(15.6%) patients experienced relapse and metastasis,8 (12.5%)patients died of the disease in laparoscopic group.Conclusion:Compared with laparoscopic gastrectomy, robotic system for the treatment of gastric cancer is feasible and safe with the benefits of adequate lymphadenectomy, and less intraoperative blood loss. Robotic assistant distal gastrectomy offers better short-term surgical outcomes than the laparoscopic assistant distal method.