A Robot-assisted Pylorus Preserving Gastrectomy for Early Gastric Cancer: Is it better than laparoscopy-assisted surgery?

Young-Woo Kim, Hong Man Yoon, Daniel Reim, Ji Yeon Park, Bang Wool Eom, Keun Won Ryu. Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center.

 Introduction: This study was to see whether a robot assisted pylorus preserving gastrectomy (RAPPG) could show benefit over laparoscopy assisted pylorus preserving gastrectomy (LAPPG) in terms of short term surgical and oncological outcomes.

Methods: We conducted single center-based case-control study. The study included 16 patients underwent RAPPG, and 24 patients underwent LAPPG at the National Cancer Center, Korea between Feb 2012 and Dec 2012. Clinicopathologic data, operation related data, postoperative morbidity and pathologic data were analyzed by Student t-test and Chi-Square test.

Results: Age of patients was 51.7 + 10.3 in RAPPG and 57.5 + 13.1 in LAPPG. (p=0.126) BMI (kg/m2) was 24.1 + 2.9 in RAPPG and 24.1 + 3.1 in LAPPG. (p=0.945) Operating time was 222.2 + 21.9 in RAPPG and 239.0 + 62.7 in LAPPG. (p=0.238) Number of dissected lymph nodes was 33.9 + 10.4 in RAPPG and 28.0 + 9.5 in LAPPG. (p=0.083) Regarding postoperative complications, there were 1 patients (7.1%) in RAPPG and 4 patients (16.7%) in LAPPG (p=0.631). Stasis occurred in 3 patients (18.8%) after RAPPG and in 6 patients (25.0%) after LAPPG. (p=0.717) Differences of hemoglobin level between preoperative and immediate postoperative day were similar in both groups. (0.9 + 0.8 vs 0.9 + 0.7, p=0.824) Conversion rate to distal or total gastrectomy was 5.9% (1/17) in RAPPG and 11.1% (3/27) in LAPPG.(p=>0.999)

Conclusion: RAPPG was comparable to LAPPG regarding surgical and oncologic outcomes. We might need more cases to show the benefit of robotic surgery in pylorus preserving gastrectomy.

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