A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer

Lin Chen, Prof, Hongqing Xi, Weisong Shen, Dr. Chinese People’s Liberation Army General Hospital.

AIM: To perform a meta-analysis of high-quality published trials by comparing robot-assisted gastrectomy (RAG) with laparoscopy-assisted gastrectomy (LAG).

Methods: A literature search was performed in PubMed, Embase, and Web of Science databases for clinical research published before May 2013 that compared RAG with LAG. Inclusion and exclusion criteria were established and applied. Non-randomized controlled trials were assessed using modified Methodological Index for Nonrandomized Studies (MINORS) items. 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). Stata 12.0 software was used for statistical analysis.

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% CI 0.46–1.62; p < 0.05). RAG can be performed safely with lower estimated blood loss and a longer distal margin than with LAG. Complications, hospital stay, proximal margin, and harvested lymph nodes for RAG and LAG were similar. 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.

Conclusions: With acceptable complications and radical resection, RAG is a promising approach when compared with LAG.

Key Words: Gastric neoplasm; Robot-assisted gastrectomy; Laparoscopy-assisted gastrectomy; Postoperative complications; Meta-analysis

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