Conventional vs. Robotic-assisted Laparoscopic Distal Gastrectomy in Gastric Cancer: A Systematic Review Comparing the Outcomes

Andrew Raffaella, MBBS, MSC, Badria Al Araimi, Mrs, Bijendra Patel, MBBS, MS, FRCS. Barts Cancer Institute.

The objective of the study is to evaluate the outcomes of robot-assisted distal gastrectomy (RADG) and laparoscopy-assisted distal gastrectomy (LADG) in gastric cancer cases. There has not been any systematic review or meta-analysis on this topic prior to this.

This study is a systematic review of the literature following the PRISMA guidelines. Keywords for the robotic group are ‘robot*’, ‘distal’, and ‘gastrectomy’; and for the laparoscopic group are ‘laparo*’, ‘distal’, and ‘gastrectomy’. Database used were PubMed and Science Direct. Inclusion criteria were English articles from 2000 onwards, articles which include distal gastrectomy only, and articles which reported surgical outcomes. In the robotic group, only Da Vinci system studies were included and in the laparoscopic group, only RCT studies were included. Exclusion criteria were case reports or case series with < 5 patients, other reviews, meta-analyses, and other types of gastrectomy. Data were then analysed with SPSS, including the use of descriptive statistics, T-test, and Mann-Whitney U test.

11 studies were collected, 1 study consisted of 2 LADG groups and 1 RADG group and were added to each group separately for better analysis, making 7 studies in RADG group (n=81) and 6 studies in LADG group (n=287).


Table 1. Complication Rates
Group Wound Bleeding Leakage Total
LADG 0.7% 1.3% 1% 3%
RADG 1.2% 4.9% 3.7% 9.8%


In the descriptive statistics results, contradictory to its larger sample size, LADG group has lower complication rates compared to RADG group. Further analyses were then done for other parameters. With T-test, we got the mean number of complications in LADG group 6 ± 2.98 and in RADG group 2.14 ± 0.88 with p value of 0.21 as a not statistically significant result. For other parameters, we provided the table below:

Table 2. Surgical Outcomes
Parameters LADG (means ± SD) RADG (means ± SD) P Value
Operation Time 233.1 ± 32.9 302.8 ± 26.6 0.13
Blood Loss 166.1 ± 52.29 130.2 ± 28.9 0.53
Retrieved Lymph Nodes 35.7 ± 5.3 32 ± 3.2 0.57
Hospital Stay 10.6 ± 1.96 7.5 ± 1.18 0.19
Mortality 0.5 ± 0.35 0.14 ± 0.14 0.38
Conversion 0 0.57 ± 0.37 0.17

We acquired the results of no statistical significance differences in surgical outcomes between LADG and RADG.

Our research revealed that RADG are on par with LADG in terms of surgical outcomes and could be an alternative in selected cases. This could be related to uneven number of subjects between the two arms. Surgeons nowadays are fully adapted to conventional laparoscopic and this is manifested in zero number of conversions as compared to robotic group.

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