Skip to main content
Top
Published in: Journal of Robotic Surgery 5/2021

01-10-2021 | Gastrectomy | Original Article

Comparison of short-term outcomes between robotic and laparoscopic gastrectomy for gastric cancer: a propensity score-matching analysis

Authors: Hiroshi Okabe, Hideki Sunagawa, Masashi Saji, Kenjiro Hirai, Shigeo Hisamori, Shigeru Tsunoda, Kazutaka Obama

Published in: Journal of Robotic Surgery | Issue 5/2021

Login to get access

Abstract

Robotic gastrectomy (RG) is increasingly performed based on expected benefits in short-term outcomes. However, it is still unclear if RG has any advantages over laparoscopic gastrectomy (LG). A retrospective cohort study was performed in patients who underwent minimally invasive gastrectomy between January 2012 and January 2020. A total of 366 patients were enrolled and short-term outcomes were compared between RG and LG. Propensity score matching was conducted to reduce selection bias based on age, sex, body mass index, performance status, physical status, clinical T, clinical N, clinical M, tumor location, neoadjuvant chemotherapy, type of gastrectomy, and extent of lymphadenectomy. A propensity score-matching algorithm was used to select 93 patients for each group. Estimated blood loss was smaller (0 vs. 37 mL, P = 0.001), length of hospital stay was shorter (10 vs. 12 days, P = 0.012), and the time until starting a soft diet was shorter (3 vs. 4 days, P = 0.001) in RG compared to LG. The overall complication rate was also lower in RG (9.7% vs 14.0%), but the difference was not significant. There was no mortality in either group. Total gastrectomy was an independent risk factor for postoperative complications. RG can be safely performed with a similar complication rate to that in LG and may permit faster postoperative recovery and a shorter hospital stay.
Appendix
Available only for authorised users
Literature
1.
go back to reference Sakuramoto S, Sasako M, Yamaguchi T et al (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820CrossRef Sakuramoto S, Sasako M, Yamaguchi T et al (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820CrossRef
2.
go back to reference Al-Batran SE, Homann N, Pauligk C et al (2019) Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 393:1948–1957CrossRef Al-Batran SE, Homann N, Pauligk C et al (2019) Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 393:1948–1957CrossRef
3.
go back to reference Pucher PH, Aggarwal R, Qurashi M et al (2014) Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg 101:1499–1508CrossRef Pucher PH, Aggarwal R, Qurashi M et al (2014) Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg 101:1499–1508CrossRef
4.
go back to reference Saito T, Kurokawa Y, Miyazaki Y et al (2015) Which is a more reliable indicator of survival after gastric cancer surgery: postoperative complication occurrence or C-reactive protein elevation? J Surg Oncol 112:894–899CrossRef Saito T, Kurokawa Y, Miyazaki Y et al (2015) Which is a more reliable indicator of survival after gastric cancer surgery: postoperative complication occurrence or C-reactive protein elevation? J Surg Oncol 112:894–899CrossRef
5.
go back to reference Inaki N, Etoh T, Ohyama T et al (2015) A multi-institutional, prospective, phase ii feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741CrossRef Inaki N, Etoh T, Ohyama T et al (2015) A multi-institutional, prospective, phase ii feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741CrossRef
6.
go back to reference Lee HJ, Hyung WJ, Yang HK et al (2019) Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 270:983–991CrossRef Lee HJ, Hyung WJ, Yang HK et al (2019) Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 270:983–991CrossRef
7.
go back to reference Katai H, Mizusawa J, Katayama H et al (2020) Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol 5:142–151CrossRef Katai H, Mizusawa J, Katayama H et al (2020) Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol 5:142–151CrossRef
8.
go back to reference Kim W, Kim HH, Han SU et al (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage i gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRef Kim W, Kim HH, Han SU et al (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage i gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRef
9.
go back to reference Yoshida K, Honda M, Kumamaru H et al (2018) Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: a retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg 2:55–64CrossRef Yoshida K, Honda M, Kumamaru H et al (2018) Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: a retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg 2:55–64CrossRef
10.
go back to reference Hiki N, Honda M, Etoh T et al (2017) Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer 21:162–170CrossRef Hiki N, Honda M, Etoh T et al (2017) Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer 21:162–170CrossRef
11.
go back to reference Okabe H, Obama K, Tsunoda S et al (2019) Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer. Surg Today 49:820–827CrossRef Okabe H, Obama K, Tsunoda S et al (2019) Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer. Surg Today 49:820–827CrossRef
12.
go back to reference Kim HI, Han SU, Yang HK et al (2016) Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg 263:103–109CrossRef Kim HI, Han SU, Yang HK et al (2016) Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg 263:103–109CrossRef
13.
go back to reference Uyama I, Suda K, Nakauchi M et al (2019) Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer 22:377–385CrossRef Uyama I, Suda K, Nakauchi M et al (2019) Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer 22:377–385CrossRef
14.
go back to reference Suda K, Man-I M, Ishida Y et al (2015) Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 29:673–685CrossRef Suda K, Man-I M, Ishida Y et al (2015) Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 29:673–685CrossRef
15.
go back to reference Wang WJ, Li HT, Yu JP et al (2019) Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study. Surg Endosc 33:3341–3354CrossRef Wang WJ, Li HT, Yu JP et al (2019) Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study. Surg Endosc 33:3341–3354CrossRef
16.
go back to reference Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRef Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRef
17.
go back to reference Obama K, Okabe H, Hosogi H et al (2011) Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 149:15–21CrossRef Obama K, Okabe H, Hosogi H et al (2011) Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 149:15–21CrossRef
18.
go back to reference Brierley D, Gospodarowics M et al (2020) TNM classification of malignant tumours. Wiley Blackwell, New Jersey Brierley D, Gospodarowics M et al (2020) TNM classification of malignant tumours. Wiley Blackwell, New Jersey
20.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef
21.
go back to reference Okabe H, Obama K, Kan T et al (2010) Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 211:e1-6CrossRef Okabe H, Obama K, Kan T et al (2010) Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 211:e1-6CrossRef
22.
go back to reference Okabe H, Obama K, Tsunoda S et al (2014) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg 259:109–116CrossRef Okabe H, Obama K, Tsunoda S et al (2014) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg 259:109–116CrossRef
23.
go back to reference Okabe H, Obama K, Tanaka E et al (2013) Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler. Gastric Cancer 16:268–274CrossRef Okabe H, Obama K, Tanaka E et al (2013) Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler. Gastric Cancer 16:268–274CrossRef
24.
go back to reference Tsunoda S, Okabe H, Obama K et al (2014) Short-term outcomes of totally laparoscopic total gastrectomy: experience with the first consecutive 112 cases. World J Surg 38:2662–2667CrossRef Tsunoda S, Okabe H, Obama K et al (2014) Short-term outcomes of totally laparoscopic total gastrectomy: experience with the first consecutive 112 cases. World J Surg 38:2662–2667CrossRef
25.
go back to reference Hikage M, Tokunaga M, Makuuchi R et al (2017) Comparison of surgical outcomes between robotic and laparoscopic distal gastrectomy for cT1 gastric cancer. World J Surg 42:1803–1810CrossRef Hikage M, Tokunaga M, Makuuchi R et al (2017) Comparison of surgical outcomes between robotic and laparoscopic distal gastrectomy for cT1 gastric cancer. World J Surg 42:1803–1810CrossRef
26.
go back to reference Kong Y, Cao S, Liu X et al (2020) Short-term clinical outcomes after laparoscopic and robotic gastrectomy for gastric cancer: a propensity score matching analysis. J Gastrointest Surg 24:531–539CrossRef Kong Y, Cao S, Liu X et al (2020) Short-term clinical outcomes after laparoscopic and robotic gastrectomy for gastric cancer: a propensity score matching analysis. J Gastrointest Surg 24:531–539CrossRef
27.
go back to reference Ye SP, Shi J, Liu DN et al (2020) Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center. Sci Rep 10:6502CrossRef Ye SP, Shi J, Liu DN et al (2020) Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center. Sci Rep 10:6502CrossRef
28.
go back to reference Chen K, Pan Y, Zhang B et al (2017) Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg 17:93CrossRef Chen K, Pan Y, Zhang B et al (2017) Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg 17:93CrossRef
29.
go back to reference Hoshino N, Murakami K, Hida K et al (2020) Robotic versus laparoscopic surgery for gastric cancer: an overview of systematic reviews with quality assessment of current evidence. Updates Surg 72:573–582CrossRef Hoshino N, Murakami K, Hida K et al (2020) Robotic versus laparoscopic surgery for gastric cancer: an overview of systematic reviews with quality assessment of current evidence. Updates Surg 72:573–582CrossRef
30.
go back to reference Etoh T, Honda M, Kumamaru H et al (2017) Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc 32:2766–2773CrossRef Etoh T, Honda M, Kumamaru H et al (2017) Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc 32:2766–2773CrossRef
31.
go back to reference Yang K, Cho M, Roh CK et al (2019) Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. Surg Endosc 33:2357–2363CrossRef Yang K, Cho M, Roh CK et al (2019) Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. Surg Endosc 33:2357–2363CrossRef
32.
go back to reference Sano T, Sasako M, Yamamoto S et al (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy–Japan Clinical Oncology Group study 9501. J Clin Oncol 22:2767–2773CrossRef Sano T, Sasako M, Yamamoto S et al (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy–Japan Clinical Oncology Group study 9501. J Clin Oncol 22:2767–2773CrossRef
33.
go back to reference Obama K, Kim YM, Kang DR et al (2018) Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer 21:285–295CrossRef Obama K, Kim YM, Kang DR et al (2018) Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer 21:285–295CrossRef
34.
go back to reference Yu J, Huang C, Sun Y et al (2019) Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the class-01 randomized clinical trial. JAMA 321:1983–1992CrossRef Yu J, Huang C, Sun Y et al (2019) Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the class-01 randomized clinical trial. JAMA 321:1983–1992CrossRef
Metadata
Title
Comparison of short-term outcomes between robotic and laparoscopic gastrectomy for gastric cancer: a propensity score-matching analysis
Authors
Hiroshi Okabe
Hideki Sunagawa
Masashi Saji
Kenjiro Hirai
Shigeo Hisamori
Shigeru Tsunoda
Kazutaka Obama
Publication date
01-10-2021
Publisher
Springer London
Published in
Journal of Robotic Surgery / Issue 5/2021
Print ISSN: 1863-2483
Electronic ISSN: 1863-2491
DOI
https://doi.org/10.1007/s11701-020-01182-4

Other articles of this Issue 5/2021

Journal of Robotic Surgery 5/2021 Go to the issue