Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes

Weisong Shen, MD, Hongqing Xi, MD, Kecheng Zhang, Shibo Bian, Bo Wei, Lin Chen, MD, PhD. Chinese People’s Liberation Army General Hospital

INTRODUCTION: Robot-assisted gastrectomy (RAG) is a new minimally invasive surgical technique for gastric cancer. This study was designed to compare RAG with laparoscopy-assisted gastrectomy (LAG) in short-term surgical outcomes and evaluate the comparative safety and efficacy of RAG for gastric cancer.

METHODS AND PROCEDURES: Between October 2011 and August 2014, 511 patients underwent robotic or laparoscopic gastrectomy for gastric cancer: 122 RAG and 389 LAG. A retrospective data of patients were collected. We performed a comparative analysis between RAG group and LAG group for clinicopathological characteristics and short-term surgical outcomes.

RESULTS: All the operations were performed successfully without conversion. RAG was associated with a longer operative time (257.1 ± 74.5 vs. 226.2 ± 61.3, P < 0.001), lower blood loss (176.6 ± 217.2 vs. 212.5 ± 198.8, P = 0.001) and more harvested lymph nodes (33 ± 8.5 vs. 31.3 ± 9.5, P = 0.047). Only 3 patients in LAG group had positive margins, and R0 resection rate for RAG and LAG were similar (P = 0.769). The RAG group had postoperative complications of 9.8%, comparable with those of the LAG group (P = 0.78). Proximal margin, distal margin, hospital stay, days of first flatus and days of eating liquid diet for RAG and LAG were similar. In the subgroup of serosa-negative patients, RAG had a longer operation time (255.6 ± 84.1 vs. 219.6 ± 59.2, P = 0.003), less intraoperative blood loss (151.6 ± 146.1 vs. 202.9 ± 209.1, P = 0.005) and more harvested lymph nodes (31.8 ± 7.7 vs. 29.3 ± 9.5, P = 0.04). However, in the subgroup of serosa-positive patients, RAG had a longer operation time (258.7 ± 62.9 vs. 230.4 ± 62.4, P = 0.001), but no less intraoperative blood loss (204.1 ± 274 vs. 218.6 ± 192.3, P = 0.139). Similarly, in the subgroup of total gastrectomy patients, RAG had a longer operation time (274.5 ± 55.5 vs. 249.2 ± 62.2, P = 0.018), but no less intraoperative blood loss (207.1 ± 157.4 vs. 275.3 ± 245.3, P = 0.173), no more harvested lymph nodes (36.3 ± 9.1 vs. 34 ± 9.5, P = 0.286).

CONCLUSIONS: The comparative study demonstrates that RAG is as acceptable as LAG in terms of surgical and oncologic outcomes. With lower estimated blood loss, acceptable complications and radical resection, RAG is a promising approach for the treatment of gastric cancer. However, the indication of patients for RAG is critical.