Short-term Outcomes Of Robotic Versus Laparoscopic Distal Gastrectomy For Gastric Cancer

Background: Despite the increasing use of robotic distal gastrectomy(RDG)in patients with gastric cancer(GC),its safety and efficacy compared to those of laparoscopic distal gastrectomy(LDG)have not been elucidated in a randomized controlled trial(RCT).Objective: To evaluate the short-term outcomes of patients with GC who received RDG or LDG.MethodsPatients with potentially resectable gastric adenocarcinoma(clinical tumor stage c T1-c T4 a,N0/+,M0)were enrolled in this RCT.The postoperative recovery data,postoperative complication,number of retrieved lymph nodes(LNs),rate of lymph node noncompliance,and time to initiate adjuvant chemotherapy were compared between the groups in a modified intention-to-treat analysis.ResultsBetween September 2017 and January 2020,a total of 300 patients were randomly assigned to either RDG group or LDG group.The modified intention-to-treat analysis included data from 283 patients(RDG group: n=141)and(LDG group: n=142).The clinicopathological characteristics(including age,sex and so on.)were balanced between the two groups(all P>0.05).Patients in the RDG group exhibited faster postoperative recovery,milder inflammatory responses,and reduced postoperative morbidity(9.2% vs.17.6%,respectively,P=0.039).Overall,the mean total number of examined lymph nodes(ELNs)in the RDG and LDG groups was similar(40.9 ± 11.2vs.39.9 ± 12.2,respectively,P=0.452).Furthermore,we divided the LNs into perigastric regions(stations 1–6)and extraperigastric regions(stations 7–9,11 p,and12a).The number of perigastric ELNs was similar between the RDG and LDG groups(23.3 ± 8.6 vs.24.0 ± 9.0,P=0.500).However,the number of ELNs in the extraperigastric regions in the RDG group was significantly higher than that in the LDG group(17.6 ± 5.8 vs.15.8 ± 6.6,P=0.018).The number of ELNs in station No.12 a was significantly higher in the RDG group than in the LDG group(2.5 ± 2.3 vs.1.8 ± 2.3,respectively,P=0.011).The LN noncompliance rate of the RDG group(24.8%)was significantly lower than that of the LDG group(40.1%,P=0.006).Additionally,patients in the RDG group were more likely to initiate adjuvant chemotherapy earlier(median [interquartile range] postoperative days: 28 [24-32] vs.32 [26-42],P=0.003).ConclusionsRDG is associated with a lower morbidity rate,faster recovery,milder inflammatory responses,and improved lymphadenectomy.Additionally,faster postoperative recovery in the RDG group enables early initiation of adjuvant chemotherapy.Our results provide high-level evidence for the application of RDG in patients with GC.