Potential Advantages of Robot-Assisted Gastrectomy Over Laparoscopy-assisted Gastrectomy Regarding Lymphadenectomy in Gastric Cancer

Kecheng Zhang, Hongqing Xi, Jianxin Cui, Shibo Bian, Liangang Ma, Jiyang Li, Bo Wei, Lin Chen. Department of General Surgery, Chinese People’s Liberation Army of General Hospital

Purpose: Previously we have performed retrospective analysis to compare robot-assisted gastrectomy (RAG) with laparoscopy-assisted gastrectomy in short-term surgical outcomes, and have demonstrated the feasibility and safety of robotic surgery for gastrectomy. In present study, we conducted prospective and comparative analysis to investigate the ability of RAG versus LAG to remove lymph nodes in technically demanding areas.

Methods: Between August 2014 and August 2015, sixty-one patients who underwent RAG and 235 patients who underwent LAG were enrolled in this study. Clinical characteristics, operative parameters, pathological and oncological data were collected prospectively and numbers of retrieved lymph nodes for each station were analyzed according to the extent of surgery.

Results: Days of first flatus were 4.6 ± 1.1 days for RAG and 4.4 ± 0.9 days for LAG (P = 0.142). Days of eating diet were 5.3 ± 3.7 days for RAG and 5.8 ± 4.1 days for LAG (P = 0.388). There were similar intraoperative blood transfusion rate (P = 0.617), postoperative hospital days (P = 0.071), proximal resection margin (P = 0.064) and distal resection margin (P = 0.667) between the two groups. Numbers of postoperative complications were also similar between the robotic and laparoscopic groups (P = 0.854). However, robotic surgery had less severity of complications when complications were graded according to the Clavien-Dindo classification (P = 0.039). More numbers of lymph nodes were retrieved in the RAG group than that of LAG group (P = 0.046). Similarly, the RAG group had more retrieved lymph nodes in N2 area (P = 0.038). In patients who underwent distal gastrectomy, the numbers of retrieved lymph nodes around splenic artery area were 2.8 ± 1.7 and 2.2 ± 1.2 for RAG and LAG respectively (P = 0.036). In patients who underwent total gastrectomy, 2.8 ± 1.2 and 2.1 ± 1.0 lymph nodes were retrieved for RAG and LAG around splenic artery area (P = 0.049). In addition, 1.8 ± 0.8 and 1.3 ± 0.7 lymph nodes were retrieved around splenic hilum (P = 0.042).

Conclusion: Our study demonstrates that RAG has advantages over LAG regarding lymph nodes dissection in technically demanding area and might contribute to radical D2 lymphadenectomy with less severity of complications.

 

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