Short-term surgical outcome of robotic gastrectomy for gastric cancer: comparison with open and laparoscopic gastrectomy

Joong-Min Park, MD, PhD, Kyong-Choun Chi, MD, PhD. Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.

INTRODUCTION The aim of this study was to determine the short-term surgical outcomes of robotic gastrectomy compared with open and laparoscopic gastrectomy for the treatment of gastric cancer.

METHODS Since the da Vinci surgical system was introduced in April 2011 at Chung-Ang University Hospital, we performed 11 robotic gastrectomies, 25 open gastrectomies, and 94 laparoscopic gastrectomies for the patients with gastric cancer of a stage lower than cT2N1. Clinicopathologic findings and surgical outcomes were analyzed by comparing the three groups.

RESULTS Although the preoperative clinical stage of the patients was lower than T2N1, 76% (19/25) in open group were cT2, whereas 23% (22/94) in laparoscopic and 18% (2/11) in robotic groups were cT2 (p<0.001). Thus, the pathologic stage was more advanced in open group than in laparoscopic and robotic group (p=0.009), while type of gastrectomy and the extent of lymph node dissection were not different among the three groups. Thus, the same extent of surgery was performed in each group. Operative time was greatly longer in robotic group than in other two groups (p<0.001). Number of retrieved lymph nodes were statistically similar (37.3, 37.4, and 39.0, p=0.685). Postoperative hospital stay in robotic group (7.4 days) was shorter than those in open group (16.9 days, P<0.001) or laparoscopic group (9.5 days, p=0.002). Postoperative complication was similar in the groups. There was no open or laparoscopic conversion.

CONCLUSION The numbers of retrieved lymph nodes and the short-term clinical outcomes of robotic gastrectomy was comparable to those of open and laparoscopic gastrectomy, despite the surgeon’s familiarity with laparoscopic and open gastrectomy with lack of robotic experience. The benefits of this procedure such as earlier postoperative recovery and expected oncological merit in accurate lymph node dissection have to be proved by randomized controlled trial or well matched case-control study. Long operative time and high financial cost should be overcome.