Robotic vs. laparoscopic distal gastrectomy for gastric cancer: A propensity score-matched retrospective comparative study at a single institution

Masaki Kitazono; Makoto Fujita; Shuichiro Uchiyama; Mayumi Eguchi; Naotaka Ikeda

doi:10.1016/j.asjsur.2024.03.086

Robotic vs. laparoscopic distal gastrectomy for gastric cancer: A propensity score-matched retrospective comparative study at a single institution

Asian J Surg. 2024 Mar 26:S1015-9584(24)00518-9. doi: 10.1016/j.asjsur.2024.03.086. Online ahead of print.

Authors

Masaki Kitazono¹, Makoto Fujita², Shuichiro Uchiyama³, Mayumi Eguchi³, Naotaka Ikeda³

Affiliations

¹ Department of Surgery, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan. Electronic address: opera_2@hotmail.com.
² Division of Medical Support, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan.
³ Department of Surgery, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan.

PMID: 38538396
DOI: 10.1016/j.asjsur.2024.03.086

Abstract

Background: Although robotic surgery is becoming more widespread worldwide, it is still in its infancy. This study aimed to confirm the safety and feasibility of the induction of robotic-assisted gastric surgery at a local hospital.

Methods: For five years, between 2016 and 2020, 42 laparoscopic and 71 robotic distal gastrectomies were performed at the same institution. Patients diagnosed with gastric cancer were retrieved from the database. Propensity score matching was performed based on covariates such as Age, Sex, BMI, the American Society of Anesthesiologists Physical Status, Tumor Location, pT, and pN. Clinicopathological characteristics, surgical performance, postoperative outcomes, and pathological data were retrospectively collected and compared by the Chi-square test, the Fisher's exact test, the Student's t-test, and the Mann-Whitney U test.

Results: Billroth II reconstruction was often selected for the robotic group more than the laparoscopic group (59.4% and 15.6%, respectively). In addition, the number of lymph nodes harvested after D2 dissection tended to be more significant in the robotic group than in the laparoscopic group (52.1 ± 7.6 and 29.1 ± 3.7, respectively; p = 0.00934). The mean operative time was 271.4 ± 10.5 min for the robotic group and 220.8 ± 12.3 min for the laparoscopic group (p = 0.00005). There were no differences in short-term clinical outcomes between the two groups.

Conclusions: Although a single-center, small comparative study, the results showed that the robotic surgery group was not inferior to the laparoscopic group in feasibility and safety. Moreover, robotic surgery enables harvesting a higher number of lymph nodes, which may be more advantageous than laparoscopic surgery. This study also showed that as the surgeon gains experience with robotic surgery, its operative time becomes significantly shorter.

Keywords: Gastric cancer; Laparoscopic surgery; Lymphadenectomy; Robotic surgery.