Robotic Gastrectomies Offer a Sound Oncologic Surgical Alternative for the Treatment of Early Gastric Cancers Comparing Favorably with Laparoscopic Resections

Background: Patients diagnosed with early gastric cancers (EGC) are treated by endoscopic or surgical resections achieving five-year survival rates greater than 90% in some series. Rapidly maturing experience with laparoscopic gastrectomies and appropriate lymph node dissectionsfor the management of ECG offers these patients the many benefits of the minimally – invasive surgical (MIS) approach to their disease. While encouraged by the enlarging body of evidence world-wide supporting the use of laparoscopy in gastric cancer treatment, significantapprehension persists regarding the use of robot-assisted surgical intervention. To address some of the relevantconcerns, we offer the largest single-institutional experience on the comparative safety and efficacy of robotic to laparoscopic gastrectomies focusing our attention to oncologic principles, intraoperative factors, and postoperative complications.

Methods: Between July 2005 and April 2009, two-hundred thirty-six robot-assisted and 591 laparoscopic gastrectomies were performed for early gastric cancers with curative intent at Yonsei University Health System, Seoul, Korea. All robot-assistedgastrectomies were performed with Da Vinci Robot (Intuitive, CA). The data from these patients and their operations were prospectively collected and retrospectively analyzed. Comparisons were made between the robotic group and the laparoscopic group for preoperative patient characteristics, intraoperative factors such appropriate tumor margin, type of lymph node (LN) dissection, numbers of LN retrieved, operative time, blood loss, and postoperative morbidity and mortality.

Results: No significant difference in patients preoperative co-morbidities were foundwithhypertension being the most common medical condition of both groups. Of 236 robotic gastrectomies, D1+ α (n=5), D1 +β (n=126), and D2 (n=105) were performed with resultant average number of LN retrieved 27.2 +10.7, 36.7+14.5, and 42.4+15.5, respectively. Of 591 laparoscopic gastrectomies, D1+ α (n=10), D1 +β (n=302), and D2 (n=279) were performed with resultant average number of LN retrieved 21.2 +11.1, 35.6+13.4, and 40.1+14.5, respectively. The average operative time for robot-assisted gastrectomies was 220+44.9 minutes compared to 174+62.3 minutes for the laparoscopic method. The average blood loss for the robot-assisted cases were significantly less than the laparoscopic operations, 92.5cc compared to 148.0 cc (p<0.05). For the robotic group, the mortality was 1/236 = 0.4% and the morbidity 26/236 = 11.0%. The most commonly occurring postoperative complications intherobotic group were intraluminal bleeding (n=4) and anastomatic leak (n=4). While operative time waslongerwhen the robot was used; this increased More importantly,no statistical difference was found in the number oflymph nodesretrieved nor in the postoperative morbidity between the two groups. All specimens removed by either method had negative tumor margins. There was one postoperative mortality in the robotic gastrectomy group.

Conclusion: Our largest single institutional study of robotic gastrectomies for gastric cancer suggests that minimally invasive robot-assisted surgical approach to gastric cancer is a promising alternative to laparoscopic surgery. As we judiciously expand the application of robotic technology in surgical oncology, continued critical evaluation of the emerging data is necessary.

Session: Podium Presentation

Program Number: S049

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