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Li W, Wei SJ. Perioperative outcomes of robot-assisted versus laparoscopic distal gastrectomy for gastric cancer: a systematic review and meta-analysis of propensity score matching studies. J Robot Surg 2024; 18:333. [PMID: 39231865 DOI: 10.1007/s11701-024-02038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 09/06/2024]
Abstract
The aim of this meta-analysis was to compare the efficacy of robot distal gastrectomy (RDG) versus laparoscopic distal gastrectomy (LDG) for gastric cancer. Studies included only those that utilized propensity score matching (PSM). A systematic literature search was conducted in several major global databases, including PubMed, Embase, and Google Scholar, up to June 2024. Articles were screened based on predefined inclusion and exclusion criteria. Baseline data and primary and secondary outcome measures (e.g., operative time, estimated blood loss, lymph-node yield dissection, length of hospital stay, and time to first flatus) were extracted. The quality of PSM studies was assessed using the ROBINS-I, and data were analyzed using Review Manager 5.4.1 software. A total of 12 propensity score-matched studies involving 3688 patients were included in this meta-analysis. Robot-assisted surgery resulted in a longer operative time (WMD 30.64 min, 95% CI 15.63 - 45.66; p < 0.0001), less estimated blood loss (WMD 29.54 mL, 95% CI - 47.14 - 11.94; p = 0.001), more lymph-node yield (WMD 5.14, 95% CI 2.39 - 7.88; p = 0.0002), and a shorter hospital stay (WMD - 0.36, 95% CI - 0.60 - 0.12; p = 0.004) compared with laparoscopic surgery. There were no significant differences between the two surgical methods in terms of time to first flatus, overall complications, and major complications. Robot distal gastrectomy for gastric cancer reduces intraoperative blood loss, increases lymph-node yield, and shortens hospital stay compared with laparoscopic surgery, despite a longer operative time. There are no significant differences in time to first flatus and complication rates between the two groups.
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Affiliation(s)
- Wei Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shou-Jiang Wei
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Ma S, Fang W, Zhang L, Chen D, Tian H, Ma Y, Cai H. Experience sharing on perioperative clinical management of gastric cancer patients based on the "China Robotic Gastric Cancer Surgery Guidelines". Perioper Med (Lond) 2024; 13:84. [PMID: 39054562 PMCID: PMC11271040 DOI: 10.1186/s13741-024-00402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/20/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND With the popularization of robotic surgical systems in the field of surgery, robotic gastric cancer surgery has also been fully applied and promoted in China. The Chinese Guidelines for Robotic Gastric Cancer Surgery was published in the Chinese Journal of General Surgery in August 2021. METHODS We have made a detailed interpretation of the process of robotic gastric cancer surgery regarding the indications, contraindications, perioperative preparation, surgical steps, complication, and postoperative management based on the recommendations of China's Guidelines for Robotic Gastric Cancer Surgery and supplemented by other surgical guidelines, consensus, and single-center experience. RESULTS Twenty experiences of perioperative clinical management of robotic gastric cancer surgery were described in detail. CONCLUSION We hope to bring some clinical reference values to the front-line clinicians in treating robotic gastric cancer surgery. TRIAL REGISTRATION The guidelines were registered on the International Practice Guideline Registration Platform ( http://www.guidelines-registry.cn ) (registration number: IPGRP-2020CN199).
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Affiliation(s)
- Shixun Ma
- The First School of Clinical Medicine, Lanzhou University, 1st West Donggang R.D, Lanzhou, 730000, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Wei Fang
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Leisheng Zhang
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Dongdong Chen
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
- The Second School of Clinical Medicine, Lanzhou University, 82st Cuiyingmeng R.D, Lanzhou, 730030, China
| | - Hongwei Tian
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Yuntao Ma
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
| | - Hui Cai
- The First School of Clinical Medicine, Lanzhou University, 1st West Donggang R.D, Lanzhou, 730000, China.
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
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Zhong Q, Tang YH, Liu ZY, Zhang ZQ, He QC, Li P, Xie JW, Wang JB, Lin JX, Lu J, Chen QY, Zheng CH, Huang CM. Long-term survival outcomes of robotic total gastrectomy for locally advanced proximal gastric cancer: a prospective study. Int J Surg 2024; 110:4132-4142. [PMID: 38537085 PMCID: PMC11254278 DOI: 10.1097/js9.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/03/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Robotic gastrectomy is a safe and feasible approach for gastric cancer (GC); however, its long-term oncological efficacy remains unclear. The authors evaluated the long-term survival outcomes and recurrence patterns of patients with locally advanced proximal GC who underwent robotic total gastrectomy (RTG). METHODS This prospective study (FUGES-014 study) enrolled 48 patients with locally advanced proximal GC who underwent RTG between March 2018 and February 2020 at a tertiary referral teaching hospital. Patients who underwent laparoscopic total gastrectomy (LTG) in the FUGES-002 study were enrolled in a 2:1 ratio to compare the survival outcomes between RTG and LTG. The primary endpoint of the FUGES-014 study was postoperative 30-day morbidity and has been previously reported. Here, the authors reported the results of 3-year disease-free survival (DFS), 3-year overall survival (OS), and recurrence patterns. RESULTS After propensity score matching, 48 patients in the RTG and 96 patients in the LTG groups were included. The 3-year DFS rates were 77.1% (95% CI: 66.1-89.9%) for the RTG and 68.8% (95% CI: 60.1-78.7%) for the LTG groups ( P =0.261). The 3-year OS rates were not significantly different between the groups (85.4 vs. 74.0%, P =0.122). Recurrence occurred in nine patients (18.8%) in the RTG and 27 (28.1%) patients in the LTG groups ( P =0.234). Recurrence patterns and causes of death were similar between the groups ( P >0.05). CONCLUSIONS The oncological outcome of RTG was noninferior to that of LTG. Thus, RTG might be an alternative surgical treatment for locally advanced proximal GC.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yi-Hui Tang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Zhi-Quan Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Qi-Chen He
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
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Zheng YM, Luo ZY, Li ZY, Liu JJ, Ren ZX, Wang JJ, Yu PW, Shi Y, Zhao YL, Qian F. Comparison of totally robotic and totally laparoscopic gastrectomy for gastric cancer: a propensity score matching analysis. Surg Endosc 2024:10.1007/s00464-024-10924-6. [PMID: 38902410 DOI: 10.1007/s00464-024-10924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/04/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND With the improvements in laparoscopic or robotic surgical techniques and instruments, a growing number of surgeons have attempted to complete all digestive tract reconstruction intracorporeally; these procedures include totally robotic gastrectomy (TRG) and totally laparoscopic gastrectomy (TLG). This study aimed to evaluate the safety and feasibility of the TRG and compare the short-term outcomes of the TRG and TLG in patients with gastric cancer. METHODS Between January 2018 and June 2023, 346 consecutive patients who underwent TRG or TLG at a high-volume academic gastric cancer specialty center were included. 1:1 propensity score matching (PSM) was performed to reduce confounding bias. The surgical outcomes, postoperative morbidity, and surgical burden were compared in PSM cohort. RESULTS After PSM, a well-balanced cohort of 194 patients (97 in each group) was included in the analysis. The total operation time of the TRG group was significantly longer than that of the TLG group (244.9 vs. 213.0 min, P < 0.001). There was no significant difference in the effective operation time between the 2 groups (217.8 vs. 207.2 min, P = 0.059). The digestive tract reconstruction time of the TRG group was significantly shorter than that of the TLG group (39.4 vs. 46.7 min, P < 0.001). The mean blood loss in the TRG group was less than that in the TLG group (101.1 vs. 126.8 mL, P = 0.014). The TRG group had more retrieved lymph nodes in the suprapancreatic area than that in the TLG group (16.6 vs 14.2, P = 0.002). The TRG group had a lower surgery task load index (38.9 vs. 43.1, P < 0.001) than the TLG group. No significant difference was found in terms of postoperative morbidity between the 2 groups (14.4% vs. 16.5%, P = 0.691). CONCLUSION This study demonstrated that TRG is a safe and feasible procedure, and is preferable to TLG in terms of invasion and ergonomics. The TRG may maximize the superiority of robotic surgical systems and embodies the theory of minimally invasive surgery.
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Affiliation(s)
- Yi-Ming Zheng
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Zi-Yan Luo
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Zheng-Yan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China.
| | - Jia-Jia Liu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Zhi-Xiang Ren
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Jun-Jie Wang
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Pei-Wu Yu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Yan Shi
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Yong-Liang Zhao
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Feng Qian
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China.
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Wei LH, Zheng HL, Xue Z, Xu BB, Zheng HH, Shen LL, Zheng ZW, Xie JW, Zheng CH, Huang CM, Chen QY, Li P. Robotic gastrectomy was reliable option for overweight patients with gastric cancer: a propensity score matching study. Surg Endosc 2024; 38:3156-3166. [PMID: 38627257 DOI: 10.1007/s00464-024-10845-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/02/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The role of minimally invasive surgery using robotics versus laparoscopy in resectable gastric cancer patients with a high body mass index (BMI) remains controversial. METHODS A total of 482 gastric adenocarcinoma patients with BMI ≥ 25 kg/m2 who underwent minimally invasive radical gastrectomy between August 2016 and December 2019 were retrospectively analyzed, including 109 cases in the robotic gastrectomy (RG) group and 321 cases in the laparoscopic gastrectomy (LG) group. Propensity score matching (PSM) with a 1:1 ratio was performed, and the perioperative outcomes, lymph node dissection, and 3-year overall survival (OS) and disease-free survival (DFS) rates were compared. RESULTS After PSM, 109 patients were included in each of the RG and LG groups, with balanced baseline characteristics. Compared with the LG group, the RG group had similar intraoperative estimated blood loss [median (IQR) 30 (20-50) vs. 35 (30-59) mL, median difference (95%CI) - 5 (- 10 to 0)], postoperative complications [13.8% vs. 18.3%, OR (95%CI) 0.71 (0.342 to 1.473)], postoperative recovery, total harvested lymph nodes [(34.25 ± 13.43 vs. 35.44 ± 14.12, mean difference (95%CI) - 1.19 (- 4.871 to 2.485)] and textbook outcomes [(81.7% vs. 76.1%, OR (95%CI) 1.39 (0.724 to 2.684)]. Among pathological stage II-III patients receiving chemotherapy, the initiation of adjuvant chemotherapy in the RG group was similar to that in the LG group [median (IQR): 28 (25.5-32.5) vs. 32 (27-38.5) days, median difference (95%CI) - 3 (- 6 to 0)]. The 3-year OS (RG vs. LG: 80.7% vs. 81.7%, HR = 1.048, 95%CI 0.591 to 1.857) and DFS (78% vs. 76.1%, HR = 0.996, 95%CI 0.584 to 1.698) were comparable between the two groups. CONCLUSION RG conferred comparable lymph node dissection, postoperative recovery, and oncologic outcomes in a selected cohort of patients with BMI ≥ 25 kg/m2.
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Affiliation(s)
- Ling-Hua Wei
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Hong-Hong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Zhi-Wei Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China.
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China.
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Lu J, Xu BB, Zheng HL, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Yao ZH, Zheng CH, Huang CM. Robotic versus laparoscopic distal gastrectomy for resectable gastric cancer: a randomized phase 2 trial. Nat Commun 2024; 15:4668. [PMID: 38821945 PMCID: PMC11143299 DOI: 10.1038/s41467-024-49013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
Robotic surgery may be an alternative to laparoscopic surgery for gastric cancer (GC). However, randomized controlled trials (RCTs) reporting the differences in survival between these two approaches are currently lacking. From September 2017 to January 2020, 300 patients with cT1-4a and N0/+ were enrolled and randomized to either the robotic (RDG) or laparoscopic distal gastrectomy (LDG) group (NCT03313700). The primary endpoint was 3-year disease-free survival (DFS); secondary endpoints reported here are the 3-year overall survival (OS) and recurrence patterns. The remaining secondary outcomes include intraoperative outcomes, postoperative recovery, quality of lymphadenectomy, and cost differences, which have previously been reported. There were 283 patients in the modified intention-to-treat analysis (RDG group: n = 141; LDG group: n = 142). The trial has met pre-specified endpoints. The 3-year DFS rates were 85.8% and 73.2% in the RDG and LDG groups, respectively (p = 0.011). Multivariable Cox regression model including age, tumor size, sex, ECOG PS, lymphovascular invasion, histology, pT stage, and pN stage showed that RDG was associated with better 3-year DFS (HR: 0.541; 95% CI: 0.314-0.932). The RDG also improved the 3-year cumulative recurrence rate (RDG vs. LDG: 12.1% vs. 21.1%; HR: 0.546, 95% CI: 0.302-0.990). Compared to LDG, RDG demonstrated non-inferiority in 3-year DFS rate.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Zi-Hao Yao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China.
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7
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Tsuji T, Inaki N, Takenaka S, Mitta K, Hayashi S, Shimada M, Saito H, Yamamoto D, Moriyama H, Kinoshita J. Initial 12 Cases of Robot-Assisted Gastrectomy for Gastric Cancer Using the Hinotori Surgical Robot System: Tips for the Efficient Introduction of a New Surgical Robot. J Laparoendosc Adv Surg Tech A 2024; 34:393-400. [PMID: 38593412 DOI: 10.1089/lap.2023.0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Introduction: The use of robotic platform for gastrectomy for gastric cancer is rapidly increasing. This study aimed to describe the perioperative outcomes of 12 patients who underwent robotic gastrectomy for gastric cancer using the hinotori™ surgical robot system (hinotori), a novel robot-assisted surgical platform, and compare the outcomes with the existing system, the da Vinci® Surgical System (DVSS). Methods: This study included 12 consecutive patients with gastric cancer who underwent robotic gastrectomy for gastric cancer using the hinotori between March 2023 and September 2023 at our institution. The comprehensive perioperative outcomes of these patients were retrospectively analyzed and compared to 11 patients who underwent robotic gastrectomy using the DVSS during the same period. Results: The median age and body mass index were 71 years (range: 56-86) and 22.7 kg/m2 (range: 16.1-26.7). Distal and total gastrectomy were performed in 8 and 4 patients, respectively. The median console time and operation times were 187 (range: 112-270) and 252 minutes (range: 173-339), respectively. The median blood loss was 3 mL (range: 2-5). No intra- or postoperative complications were observed. There were no significant differences in perioperative outcomes between the hinotori and the DVSS. Conclusions: Robotic gastrectomy for gastric cancer using the hinotori is a feasible procedure and achieved perioperative outcomes similar to that using the DVSS. Clinical Trial Registration number: 114167-1.
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Affiliation(s)
- Toshikatsu Tsuji
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Shunsuke Takenaka
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Kazuyoshi Mitta
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Saki Hayashi
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Mari Shimada
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroto Saito
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Daisuke Yamamoto
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Hideki Moriyama
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Jun Kinoshita
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Japan
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8
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Lu J, Li TY, Zhang L, Wang ZK, She JJ, Jia BQ, Qin XG, Ren SY, Yao HL, Huang ZN, Liu DN, Liang H, Shi FY, Li P, Li BP, Zhang XS, Liu KJ, Zheng CH, Huang CM. Comparison of Short-term and Three-year Oncological Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Large Multicenter Cohort Study. Ann Surg 2024; 279:808-817. [PMID: 38264902 DOI: 10.1097/sla.0000000000006215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To compare the short-term and long-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. BACKGROUND The clinical outcomes of RG over LG have not yet been effectively demonstrated. METHODS This retrospective cohort study included 3599 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals in China from January 2015 to June 2019. Propensity score matching was performed between patients who received RG and LG. The primary end point was 3-year disease-free survival (DFS). RESULTS After 1:1 propensity score matching, 1034 pairs of patients were enrolled in a balanced cohort for further analysis. The 3-year DFS in the RG and LG was 83.7% and 83.1% ( P =0.745), respectively, and the 3-year overall survival was 85.2% and 84.4%, respectively ( P =0.647). During 3 years of follow-up, 154 patients in the RG and LG groups relapsed (cumulative incidence of recurrence: 15.0% vs 15.0%, P =0.988). There was no significant difference in the recurrence sites between the 2 groups (all P >0.05). Sensitivity analysis showed that RG had comparable 3-year DFS (77.4% vs 76.7%, P =0.745) and overall survival (79.7% vs 78.4%, P =0.577) to LG in patients with advanced (pathologic T2-4a) disease, and the recurrence pattern within 3 years was also similar between the 2 groups (all P >0.05). RG had less intraoperative blood loss, lower conversion rate, and shorter hospital stays than LG (all P >0.05). CONCLUSIONS For resectable gastric cancer, including advanced cases, RG is a safe approach with comparable 3-year oncological outcomes to LG when performed by experienced surgeons.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Tai-Yuan Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Zu-Kai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jun-Jun She
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bao-Qing Jia
- Department of General Surgery, The First Medical Centre, PLA General Hospital, Beijing, China
| | - Xin-Gan Qin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shuang-Yi Ren
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hong-Liang Yao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Dong-Ning Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Han Liang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Fei-Yu Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Peng Li
- Department of General Surgery, The First Medical Centre, PLA General Hospital, Beijing, China
| | - Bo-Pei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin-Sheng Zhang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Kui-Jie Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
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9
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Chen X, Zhang Y, Liu Z, Song J, Li J. The inflammation score predicts the prognosis of gastric cancer patients undergoing Da Vinci robot surgery. J Robot Surg 2024; 18:131. [PMID: 38498240 DOI: 10.1007/s11701-024-01840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/21/2024] [Indexed: 03/20/2024]
Abstract
Neutrophil-to-lymphocyte ratio (NLR), calculated from peripheral blood immune-inflammatory cell counts, is considered a predictor of survival in various cancers. Nevertheless, there is a lack of research into the predictive value of NLR specifically in gastric cancer patients following surgery using the Da Vinci robot. Investigate the objectives of this research, confirm the positive predictive value of NLR in the prognosis of gastric cancer patients undergoing Da Vinci robotic-assisted surgery by comparing its prognostic ability with other inflammation markers and tumor biomarkers. In this retrospective analysis, information from 128 individuals diagnosed with gastric cancer and treated with da Vinci robot-assisted surgery was examined. The study examined various markers in the peripheral blood, including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), systemic immune-inflammatory index (SII) prognostic nutrition index (PNI), cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 72-4 (CA72-4), carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP).To ascertain the prognostic ability and optimal cutoff values of each parameter, operating characteristic curves and the area under the curve were utilized in the analysis. For evaluation of independent prognostic factors, we utilized Kaplan-Meier curves and multifactorial Cox analysis. The variables from the multifactorial Cox analysis were used to construct a nomogram. NLR, LMR, CEA, AFP, primary location, largest tumor size and TNM stage were all found to be significant predictive elements for overall survival (OS). Multivariate Cox identified NLR (P = 0.005), LMR (P = 0.03) and AFP (P = 0.007) as the only separate predictive variables among hematological indicators. The nomogram built using NLR demonstrates excellent predictive performance at 1 year (AUC = 0.778), 3 years (AUC = 0.773), and 5 years (AUC = 0.781). Cross-validation demonstrates that this model has favorable predictive performance and discriminative ability. NLR is an uncomplicated yet potent marker for forecasting the survival result of individuals with gastric cancer following da Vinci robotic surgery, and it possesses considerable predictive significance. The nomogram based on NLR provides patients with a visual and accurate prognosis prediction.
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Affiliation(s)
- Xihao Chen
- Xijing Hospital, Fourth Military Medical University, Department of Gastrointestinal Surgery, Xi'an, 710032, China
- Xi'an Medical University, Xi'an, 710068, China
| | - Yichao Zhang
- Xijing Hospital, Fourth Military Medical University, Department of Gastrointestinal Surgery, Xi'an, 710032, China
| | - Zhiyu Liu
- Xijing Hospital, Fourth Military Medical University, Department of Gastrointestinal Surgery, Xi'an, 710032, China
- Xi'an Medical University, Xi'an, 710068, China
| | - Jiawei Song
- Xijing Hospital, Fourth Military Medical University, Department of Gastrointestinal Surgery, Xi'an, 710032, China
- Xi'an Medical University, Xi'an, 710068, China
| | - Jipeng Li
- Xi'an Medical University, Xi'an, 710068, China.
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10
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Li ZY, Wei B, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Qin XG, Hu JK, Li YX, Qian F, Shi Y, Cui H, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yu LJ, Yang K, Zhang SX, Yu PW, Zhao YL. Long-term oncological outcomes of robotic versus laparoscopic gastrectomy for gastric cancer: multicentre cohort study. Br J Surg 2024; 111:znad435. [PMID: 38215239 DOI: 10.1093/bjs/znad435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND The aim of this multicentre cohort study was to compare the long-term oncological outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for patients with gastric cancer. METHODS Patients with gastric cancer who underwent radical gastrectomy by robotic or laparoscopic approaches from 1 March 2010 to 31 December 2018 at 10 high-volume centres in China were selected from institutional databases. Patients receiving RG were matched 1 : 1 by propensity score with patients undergoing LG. The primary outcome was 3-year disease-free survival. Secondary outcomes were overall survival and disease recurrence. RESULTS Some 2055 patients who underwent RG and 4309 patients who had LG were included. The propensity score-matched cohort comprised 2026 RGs and 2026 LGs. Median follow-up was 41 (i.q.r. 39-58) months for the RG group and 39 (38-56) months for the LG group. The 3-year disease-free survival rates were 80.8% in the RG group and 79.5% in the LG group (log rank P = 0.240; HR 0.92, 95% c.i. 0.80 to 1.06; P = 0.242). Three-year OS rates were 83.9 and 81.8% respectively (log rank P = 0.068; HR 0.87, 0.75 to 1.01; P = 0.068) and the cumulative incidence of recurrence over 3 years was 19.3% versus 20.8% (HR 0.95, 0.88 to 1.03; P = 0.219), with no difference between groups. CONCLUSION RG and LG in patients with gastric cancer are associated with comparable disease-free and overall survival.
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Affiliation(s)
- Zheng-Yan Li
- Department of General Surgery, Centre for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bo Wei
- Department of General Surgery, Chinese PLA General Hospital First Medical Centre, Beijing, China
| | - Yan-Bing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tai-Yuan Li
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ji-Peng Li
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhi-Wei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Jun-Jun She
- Department of General Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xin-Gan Qin
- Department of Gastrointestinal Gland Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Xiang Li
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Feng Qian
- Department of General Surgery, Centre for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, Centre for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hao Cui
- Department of General Surgery, Chinese PLA General Hospital First Medical Centre, Beijing, China
| | - Yu-Long Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Geng-Mei Gao
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui-Zi Gao
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Cai Liang
- Department of Gastric Surgery, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Fei-Yu Shi
- Department of General Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li-Jun Yu
- Department of Gastrointestinal Gland Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Kun Yang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Shang-Xin Zhang
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pei-Wu Yu
- Department of General Surgery, Centre for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, Centre for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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11
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He H, Liu Y, Liu X, Zhang Z, Wang D, Fu W. Evaluation of different scoring systems in the prediction of complications, morbidity, and mortality after laparoscopic radical gastrectomy. World J Surg Oncol 2023; 21:388. [PMID: 38110969 PMCID: PMC10726546 DOI: 10.1186/s12957-023-03282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND This retrospective study aimed to assess the suitability of POSSUM and its modified versions, E-PASS and its modified score, SRS, and SORT scores for predicting postoperative complications and mortality in patients undergoing laparoscopic radical gastrectomy for gastric cancer. MATERIALS AND METHODS Data analysis was performed on 349 patients who underwent laparoscopic radical gastrectomy at Tianjin Medical University General Hospital between January 2016 and December 2021. The discriminative ability of the scoring systems was evaluated using the area under the receiver operating characteristic curve (AUC). The primary endpoint focused on the prediction of postoperative complications, while the secondary endpoint assessed the prediction of postoperative mortality. RESULTS Among the scoring systems evaluated, the modified E-PASS (mE-PASS) score exhibited the highest AUC (0.846) and demonstrated the highest sensitivity (81%) and specificity (79%) for predicting postoperative complications. All other scores, except for POSSUM, showed moderate discriminative ability in predicting complications. In terms of predicting postoperative mortality, the E-PASS score had the highest AUC (0.978), while the mE-PASS score displayed the highest sensitivity (76%) and specificity (90%). Notably, both E-PASS and mE-PASS scores exhibited excellent discriminative ability. CONCLUSIONS The P-POSSUM, O-POSSUM, E-PASS, mE-PASS, SRS, and SORT scoring systems are useful tools for predicting postoperative outcomes in laparoscopic radical gastrectomy. Among them, the mE-PASS score demonstrated the best predictive power. However, the POSSUM system could only be applicable to predict postoperative mortality.
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Affiliation(s)
- Haoyu He
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Yubiao Liu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China
- Department of Anorectal Surgery, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Xin Liu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Zhaoxiong Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Daohan Wang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Weihua Fu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China.
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12
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Kossenas K, Georgopoulos F. The Evolving Surgical Landscape: A Comprehensive Review of Robotic Versus Laparoscopic Gastrectomy for the Treatment of Gastric Cancer. Cureus 2023; 15:e49780. [PMID: 38161532 PMCID: PMC10757755 DOI: 10.7759/cureus.49780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Robotic gastrectomy has been gaining ground in the past 20 years. This study aims to (a) provide an updated and all-encompassing comprehensive review including post-operative outcomes, rate of complications, surgical efficiency and costs, pathology, overall survival, mortality and recurrence, and disease-free survival of robotic versus laparoscopic gastrectomy, (b) report research gaps, and (c) identify ongoing or forthcoming clinical trials that could potentially shed light on underreported findings within the existing literature. Regarding the methodology, PubMed and Google Scholar were searched for randomized controlled trials, systematic reviews, and meta-analyses published between January 2012 and October 2023. ClinicalTrials.gov was searched for related clinical trials currently underway or recruiting. Robotic gastrectomy, when compared to laparoscopic gastrectomy, for the treatment of gastric cancer, performs equally well or shows superiority in terms of the length of hospitalization, overall complications rates, rate of conversion to open surgery, surgical complications, anastomotic leakage, pancreatic complications, blood loss, mortality rates, time to first flatus, time to oral intake, distal and proximal resection margins, recurrence rate, reoperation rates, and overall survival. However, it is associated with higher costs and longer operative time. Parameters such as duodenal stump leakage, anastomosis stenosis, intestinal obstruction, ileus, delayed gastric emptying, wound complications, acute pancreatitis, pancreatic fistula, direct costs, time to initiation of adjuvant chemotherapy, postoperative morbidity, recurrence, and disease-free survival are currently underreported in the literature and necessitate for further research. Lastly, four clinical trials are currently underway or recruiting that could possibly bridge the research gap.
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13
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Lu J, Wu D, Huang JB, Lin J, Xu BB, Xue Z, Zheng HL, Lin GS, Shen LL, Li P, Wang JB, Lin JX, Chen QY, Cao LL, Xie JW, Zheng CH, Huang CM. Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation. Surg Endosc 2023; 37:7472-7485. [PMID: 37395806 DOI: 10.1007/s00464-023-10147-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/20/2023] [Indexed: 07/04/2023]
Abstract
IMPORTANCE It is largely unclear whether robotic distal gastrectomy (RDG) is cost-effective for locally advanced gastric cancer (LAGC). OBJECTIVE To evaluate the cost-effectiveness of RDG, laparoscopic distal gastrectomy (LDG), and open distal gastrectomy (ODG) for patients with LAGC. DESIGN, SETTING, AND PARTICIPANTS Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. A decision-analytic model was constructed to evaluate the cost-effectiveness of RDG, LDG, and ODG. EXPOSURES RDG, LDG, and ODG. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER) and quality-adjusted life year (QALY). RESULTS This pooled analysis of two randomized controlled trials included 449 patients: 117, 254, and 78 patients in the RDG, LDG, and ODG groups, respectively. After IPTW, RDG demonstrated its priority in terms of less blood loss, postoperative length, and complication rate (all P < 0.05). RDG also showed higher QOL with more cost, representing an ICER of $85,739.73 per QALY and $42,189.53 per QALY compared to LDG and ODG, respectively. In probabilistic sensitivity analysis, RDG achieved the best cost-effectiveness for patients with LAGC only when the willingness-to-pay threshold was > $85,739.73 per QALY, which significantly exceeded 3 times Chinese per capita GDP. Furthermore, one of the most important factors was the indirect costs of robotic surgery in terms of the cost-effectiveness of RDG compared to that of LDG or ODG. CONCLUSIONS AND RELEVANCE Although improved short-term outcomes and QOL were seen in patients underwent RDG, the economic burden should be considered in the clinical decision-making regarding robotic surgery use for patients with LAGC. Our findings may vary in different health care settings and affordability. Trial registration CLASS-01 trial (ClinicalTrials.gov, CT01609309) and FUGES-011 trial (ClinicalTrials.gov, NCT03313700).
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiao-Bao Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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14
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Davey MG, Temperley HC, O'Sullivan NJ, Marcelino V, Ryan OK, Ryan ÉJ, Donlon NE, Johnston SM, Robb WB. Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. Ann Surg Oncol 2023; 30:5544-5557. [PMID: 37261563 PMCID: PMC10409677 DOI: 10.1245/s10434-023-13654-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Optimal surgical management for gastric cancer remains controversial. We aimed to perform a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing outcomes after open gastrectomy (OG), laparoscopic-assisted gastrectomy (LAG), and robotic gastrectomy (RG) for gastric cancer. METHODS A systematic search of electronic databases was undertaken. An NMA was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using R and Shiny. RESULTS Twenty-two RCTs including 6890 patients were included. Overall, 49.6% of patients underwent LAG (3420/6890), 46.6% underwent OG (3212/6890), and 3.7% underwent RG (258/6890). At NMA, there was a no significant difference in recurrence rates following LAG (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.77-1.49) compared with OG. Similarly, overall survival (OS) outcomes were identical following OG and LAG (OS: OG, 87.0% [1652/1898] vs. LAG: OG, 87.0% [1650/1896]), with no differences in OS in meta-analysis (OR 1.02, 95% CI 0.77-1.52). Importantly, patients undergoing LAG experienced reduced intraoperative blood loss, surgical incisions, distance from proximal margins, postoperative hospital stays, and morbidity post-resection. CONCLUSIONS LAG was associated with non-inferior oncological and surgical outcomes compared with OG. Surgical outcomes following LAG and RG superseded OG, with similar outcomes observed for both LAG and RG. Given these findings, minimally invasive approaches should be considered for the resection of local gastric cancer, once surgeon and institutional expertise allows.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Republic of Ireland.
| | - Hugo C Temperley
- Department of Surgery, Trinity St. James's Cancer Institute, Trinity, St. James's Hospital, Trinity College Dublin, Dublin, Republic of Ireland
| | - Niall J O'Sullivan
- Department of Surgery, Tallaght University Hospital, Dublin, Republic of Ireland
| | - Vianka Marcelino
- Department of Surgery, St. Vincent's University Hospital, Dublin, Republic of Ireland
| | - Odhrán K Ryan
- Department of Surgery, St. Vincent's University Hospital, Dublin, Republic of Ireland
| | - Éanna J Ryan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Republic of Ireland
- Department of Surgery, St. Vincent's University Hospital, Dublin, Republic of Ireland
| | - Noel E Donlon
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Republic of Ireland
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin 9, Co Dublin, Republic of Ireland
| | - Sean M Johnston
- Department of Surgery, Midlands University Hospital, Tullamore, Co. Offaly, Republic of Ireland
| | - William B Robb
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin 9, Co Dublin, Republic of Ireland
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Lianos GD, Bali CD, Vlachos K, Drosou P, Rausei S, Mitsis M, Schizas D. Complete mesogastric excision for gastric cancer: is it the future of gastric cancer surgery? Per Med 2023; 20:461-466. [PMID: 37811582 DOI: 10.2217/pme-2023-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Gastric cancer remains undoubtedly one of the most common and deadly cancers worldwide. The global incidence shows wide geographic variation with a high prevalence in Asia. Besides that, there are evident differences in epidemiology, histopathology, tumor location, diagnosis and treatment strategy between east and west countries. Gastric cancer represents an aggressive disease, with many factors influencing its development and also recurrence after surgical resection. New knowledge of disease spread and new routes of metastases are now emerging and the 'novel' concept of complete mesogastric excision for gastric cancer is under consideration and debate. This article aims to analyze and highlight this new concept after a careful literature review, offering also a view toward the future.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Christina D Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | | | - Panagiota Drosou
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Stefano Rausei
- Department of Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, Cittiglio, 21033, Italy
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, 11527, Greece
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Lin X, Tan C, Li Z, Wu W, Cheng X, Qian F, Shi Y, Zhao Y. Long-term oncologic and surgical outcomes of robotic and laparoscopic gastrectomy for Siewert II/III esophagogastric junction carcinoma: A propensity score-matched retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106898. [PMID: 37019806 DOI: 10.1016/j.ejso.2023.03.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND This study aimed to investigate the short-term surgical and long-term survival outcomes after robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) for patients with Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). METHODS We retrospectively analyzed 84 and 312 patients with Siewert type II/III AEG who underwent RG or LG between January 2005 and September 2016 in our center. We performed a 1:2 matched propensity score matching (PSM) analysis between the RG and LG group for clinical features to reduce confounding bias. Additionally, the long- and short-term outcomes between the RG and LG group were compared. RESULTS The clinicopathological characteristics of 246 patients (RG group: n = 82; LG group: n = 164) were well balanced after PSM. Patients in the RG group showed less estimated blood loss, less time to first flatus, less time to first ambulation, less drainage tube removed time, and retrieved more lymph nodes than the LG group. The overall complication rate was comparable between the RG and LG groups. The 5-year overall survival (OS) was 44.4% in the RG group and 43.7% in the LG group (p = 0.898). The 5-year disease-free survival (DFS) was 43.2% in the RG group and 43.2% in the LG group (p = 0.990). The RG and LG groups exhibited a similar recurrence rate and pattern within 5 years after surgery. CONCLUSION Robotic gastrectomy could be a feasible and safe option for patients with Siewert II/III AEG in terms of surgical and oncologic outcomes.
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Affiliation(s)
- Xia Lin
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China; Department of Gastrointestinal Surgery, Three Gorges Hospital, Chongqing University, Chongqing, China
| | - Chenjun Tan
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhengyan Li
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Weigao Wu
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiaogao Cheng
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Feng Qian
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yongliang Zhao
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China.
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17
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Tian Y, Guo H, Hu Y, Yang P, Liu Y, Zhang Z, Ding P, Zheng T, Fan L, Zhang Z, Li Y, Zhao Q. Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. Surg Endosc 2023; 37:6761-6770. [PMID: 37221415 DOI: 10.1007/s00464-023-10122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Robot-assisted distal gastrectomy (RADG) has been used in the minimally invasive surgical treatment of gastric cancer, but the research on advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NAC) has not been reported. This study aimed to analyze the outcomes of RADG versus laparoscopic distal gastrectomy (LDG) after NAC for AGC. METHODS This was a retrospective propensity score-matched analysis from February 2020 and March 2022. Patients who underwent RADG or LDG for AGC (cT3-4a/N +) following NAC were enrolled and a propensity score-matched analysis was performed in a 1:1 manner. The patients were divided into RADG group and LDG group. The clinicopathological characteristics and short-term outcomes were observed. RESULTS After propensity score matching, 67 patients each in the RADG and LDG groups. RADG was associated with a lower intraoperative blood loss (35.6 vs. 118.8 ml, P = 0.014) and more retrieved lymph nodes (LNs) (50.7 vs. 39.5, P < 0.001), more extraperigastric (18.3 vs. 10.4, P < 0.001), and suprapancreatic LNs (16.33 vs. 13.70, P = 0.042). The RADG group showed lower VAS scores at postoperative 24 h (2.2 vs 3.3, P = 0.034), earlier ambulation (1.3 vs. 2.6, P = 0.011), aerofluxus time (2.2 vs. 3.6, P = 0.025), and shorter postoperative hospital stay (8.3 vs. 9.8, P = 0.004). There were no significant differences in the operative time (216.7 vs.194.7 min, P = 0.204) and postoperative complications between the two groups. CONCLUSION RADG may be a potential therapeutic option for patients with AGC after NAC considering its advantages in perioperative period compared with LDG.
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Affiliation(s)
- Yuan Tian
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Honghai Guo
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yiyang Hu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Peigang Yang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yang Liu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Ze Zhang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Pingan Ding
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Tao Zheng
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Liqiao Fan
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Zhidong Zhang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yong Li
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Qun Zhao
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China.
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
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Yanagimoto Y, Kurokawa Y, Doki Y. Essential updates 2021/2022: Perioperative and surgical treatments for gastric and esophagogastric junction cancer. Ann Gastroenterol Surg 2023; 7:698-708. [PMID: 37663969 PMCID: PMC10472390 DOI: 10.1002/ags3.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 09/05/2023] Open
Abstract
In recent years, important clinical trials for gastric cancer (GC) and esophagogastric junction cancer (EGJC) have been reported, changing the strategies of surgical and perioperative treatment. Although laparoscopic gastrectomy has already been shown to be effective for early-stage cancer, recent evidence from both Asia (JLSSG0901, CLASS-01 and KLASS-02) and Europe (LOGICA and STOMACH trials) has demonstrated that it is useful for advanced GC. Robotic surgery has been rapidly gaining popularity in recent years, and randomized controlled trials are ongoing to evaluate its efficacy. A prospective nationwide multicenter study mapped sites with frequent metastasis and revealed lymphatic flow specific to EGJC, thus establishing the optimal lymph node dissection area and surgical approach based on esophageal involvement. Perioperative chemotherapy, the mainstay of treatment in Europe, also has been established in Asia by the PRODIGY and RESOLVE studies. New clinical trials have been conducted to evaluate the efficacy of combining immunotherapy or molecular-targeted therapy with perioperative chemotherapy or chemoradiotherapy. In this review, we present important recent clinical trials regarding the treatment of GC and EGJC published in 2021 or 2022.
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Affiliation(s)
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
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19
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Miyai H, Fujita K, Saito M, Fujii Y, Saito T, Kato J, Sawai M, Eguchi Y, Hirokawa T, Yamamoto M, Kobayashi K, Takiguchi S. Solo surgery in robot-assisted gastrectomy versus laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 2023:10.1007/s00464-023-10113-x. [PMID: 37308761 DOI: 10.1007/s00464-023-10113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Robot-assisted gastrectomy (RG) for gastric cancer is still not well standardized. This study aimed to explore the feasibility and effectiveness of solo surgery in robot-assisted gastrectomy (SRG) for gastric cancer compared to laparoscopic gastrectomy (LG). METHODS This was a single-center retrospective comparative study between SRG and conventional LG. Between April 2015 and December 2022, 510 patients underwent gastrectomy, and data from a prospectively collected database were analyzed. We identified 372 patients who underwent LG (n = 267) and SRG (n = 105) and the remaining 138 patients were excluded because of remnant gastric cancer, esophagogastric junction cancer, open gastrectomy, concurrent surgery for concomitant malignancies, RG before starting SRG, or cases in which the author was unable to perform or supervise gastrectomy. Propensity score matching was performed at a ratio of 1:1 to reduce bias from confounding patient-related variables, and short-term outcomes were compared between the groups. RESULTS After propensity score matching, 90 pairs of patients who underwent LG and SRG were selected. In the propensity-matched cohort, the operation time was significantly shorter in the SRG group than that in the LG group (SRG = 305.7 ± 74.0 min vs. LG = 340.3 ± 91.65 min, p < 0.0058), less estimated blood loss was observed in the SRG group than that in the LG group (SRG = 25.6 ± 50.6 mL vs. LG = 76.1 ± 104.2 mL, p < 0.0001) and postoperative hospital stay was shorter in the SRG group than that in the LG group (SRG = 7.1 ± 0.8 days vs. LG = 9.1 ± 7.7 days, p = 0.015). CONCLUSION We found that SRG for gastric cancer was technically feasible and effective with favorable short-term outcomes, including shorter operative time, less estimated blood loss, shorter hospital stays, and lower postoperative morbidity than those in LG.
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Affiliation(s)
- Hirotaka Miyai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan.
| | - Kohei Fujita
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Masaki Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Yoshiaki Fujii
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Tsuyoshi Saito
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Jyunki Kato
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Misato Sawai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Yuki Eguchi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Takahisa Hirokawa
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Minoru Yamamoto
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Kenji Kobayashi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
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Yu X, Zhu L, Zhang Y, Feng Q. Robotic versus laparoscopic gastrectomy for gastric cancer in patients with obesity: systematic review and meta-analysis. Front Oncol 2023; 13:1158804. [PMID: 37274257 PMCID: PMC10235683 DOI: 10.3389/fonc.2023.1158804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction The number of overweight patients with gastric cancer (GC) is increasing, and no previous study has compared laparoscopic gastrectomy (LG) and robotic gastrectomy (RG) in obese patients with GC. To investigate the perioperative and oncologic outcomes of RG and LG in obese GC patients, we performed a meta-analysis of propensity matched scores and retrospective studies to compare the perioperative parameters, oncologic findings, and short-term postoperative outcomes between the two groups. Methods This study was performed according to the PRISMA guidelines. A search was performed on PubMed, Web of Science, EMBASE, and Cochrane Central Register to identify eligible propensity matched scores and retrospective studies conducted and published before December 2022. Data on perioperative and oncological outcomes were included in the meta-analysis. Results Overall, we identified 1 propensity score match study and 5 randomized control trials of RG and LG, enrolling a total of 718 patients (197 and 521 patients received RG and LG, respectively). No significant differences were observed between the two groups in terms of complications, bleeding, or lymph node dissection. Of note, RG had a longer procedure time (P = 0.03), earlier oral intake (P = 0.0010), shorter hospital stay (P = 0.0002), and shorter time to defecation (P < 0.00001). Conclusions This meta-analysis concluded that patients in the RG group had shorter hospital stays, earlier postoperative feeding, and earlier postoperative ventilation; however, no differences were found in blood loss, number of lymph nodes removed, or overall complications. RG is an effective, safe, and promising treatment for obese patients with GC, compensating for the shortcomings of laparoscopy and allowing for less trauma and faster recovery. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022298967.
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Affiliation(s)
- Xianzhe Yu
- Department of Gastrointestinal Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Lingling Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Zhang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingbo Feng
- Department of General Surgery, Affiliated Hospital of Zunyi Medical University, Affiliated Digestive Hospital of Zunyi Medical University, Zunyi, China
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Salvador-Rosés H, Escartín A, Muriel P, Santamaría M, González M, Jara J, Vela F, Olsina JJ. Robotic versus open approach in total gastrectomy for gastric cancer: a comparative single-center study of perioperative outcomes. J Robot Surg 2023:10.1007/s11701-023-01591-1. [PMID: 37004708 DOI: 10.1007/s11701-023-01591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/26/2023] [Indexed: 04/04/2023]
Abstract
The robotic approach to gastric cancer has been gaining interest in recent years; however, its benefit over the open procedure in total gastrectomy with D2 lymphadenectomy is still controversial. The aims of the study were to compare postoperative morbidity and mortality, hospital stay, and anatomopathological findings between the robotic and open approaches to oncologic total gastrectomy. We analyzed a prospectively collected database, which included patients who underwent total gastrectomy with D2 lymphadenectomy in our center using a robotic or an open approach between 2014 and 2021. Comparative analysis of clinicopathological, intraoperative, postoperative and anatomopathological variables between the robot-assisted group and the open group was performed. Thirty patients underwent total gastrectomy with D2 lymphadenectomy by a robotic approach and 48 patients by an open procedure. Both groups were comparable. The robot-assisted group presented a lower rate of Clavien-Dindo complications ≥ stage II (20 vs. 48%, p = 0.048), a shorter hospital stay (7 days vs. 9 days, p = 0.003) and had a higher total number of lymph nodes resected (22 nodes vs. 15 nodes, p = 0.001) compared to the open approach. Operative time was longer in the robotic group (325 min vs. 195 min, p < 0.001) compared to the open group. The robotic approach is associated with a longer surgical time, a lower rate of Clavien-Dindo complications ≥ stage II and a shorter hospital stay, and more lymph nodes were resected compared to the open approach.
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Affiliation(s)
- Helena Salvador-Rosés
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain.
| | - Alfredo Escartín
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Pablo Muriel
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Maite Santamaría
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Marta González
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Jimy Jara
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Fulthon Vela
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Jorge-Juan Olsina
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
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Song Y, Zhang Q, Feng Z, Wang B, Ren S. The comparison of short-term outcomes between robotic and laparoscopic radical distal gastrectomy. Langenbecks Arch Surg 2023; 408:131. [PMID: 36991272 PMCID: PMC10060261 DOI: 10.1007/s00423-023-02866-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE The study's objectives were to compare the short-term outcomes of robotic radical distal gastrectomy (RDG) with laparoscopic radical distal gastrectomy (LDG) for patients with gastric cancer and investigate the learning curve of RDG. METHODS The cumulative sum (CUSUM) method was used to retrospectively analyze consecutive gastric cancer patients undergoing RDG between January 2019 and October 2021. The duration of surgery, clinical-pathological characteristics, and short-term outcomes were evaluated according to the two phases of the learning curve (learning period versus mastery period). We also compared the clinical-pathological characteristics and short-term outcomes between cases in the mastery period and LDG. RESULTS Data from 290 patients were included in this analysis, 135 RDG and 155 LDG cases. The learning period was 20 cases. There were no significant differences in clinical-pathological characteristics between the learning period and mastery period. Compared with the learning period, the mastery period had a significant reduction in total operation time, docking time, pure operation time, and estimated blood loss, and a significant increase in hospital costs (P=0.000, 0.000, 0.000, 0.003, and 0.026, respectively). Compared with LDG, robotic cases in mastery period had a longer operative time, shorter first postoperative flatus time, and more hospital costs (P=0.000, 0.005, and 0.000, respectively). CONCLUSIONS RGD may fasten to recover gastrointestinal function faster after the operation, can be mastered easily after a reasonable number of cases, and was associated with safe and satisfactory short-term outcomes before and after the learning curve.
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Affiliation(s)
- Yang Song
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Qianshi Zhang
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Zhen Feng
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Bo Wang
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China.
| | - Shuangyi Ren
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China.
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Li ZY, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Hu JK, Qian F, Shi Y, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yang K, Wen Y, Zhao YL, Yu PW. Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Cohort Study of 5402 Patients in China. Ann Surg 2023; 277:e87-e95. [PMID: 34225299 DOI: 10.1097/sla.0000000000005046] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A large-scale multicenter retrospective cohort study was conducted to compare the short- and long-term outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. SUMMARY OF BACKGROUND DATA RG is being increasingly used worldwide, but data from large-scale multicenter studies on the short- and long-term oncologic outcomes of RG versus LG are limited. The potential benefits of RG compared with LG for gastric cancer remain controversial. METHODS Data from eligible patients who underwent RG or LG for gastric cancer of 11 experienced surgeons from 7 centers in China between March 2010 and October 2019 were collected. The RG group was matched 1:1 with the LG group by using propensity score matching. The primary outcome was postoperative complications. RESULTS After propensity score matching, a well-balanced cohort of 3552 patients was included for further analysis. The occurrence of overall complications (12.6% vs 15.2%, P = 0.023) was lower in the RG group than in the LG group. RG was associated with less blood loss (126.8 vs 142.5 mL, P < 0.001) and more retrieved lymph nodes in total (32.5 vs 30.7, P < 0.001) and in suprapancreatic areas (13.3 vs 11.6, P < 0.001).The long-term oncological outcomes were comparable between the two groups. CONCLUSIONS The results of this multicenter study demonstrate that RG is a safe and effective treatment for gastric cancer when performed by experienced surgeons, although longer operation time and higher costs are still concerns about RG. This study provides evidence suggesting that RG may represent an alternative surgical treatment to LG.
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Affiliation(s)
- Zheng-Yan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yan-Bing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tai-Yuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ji-Peng Li
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhi-Wei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun-Jun She
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Qian
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yu-Long Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Geng-Mei Gao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui-Zi Gao
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Cai Liang
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fei-Yu Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kun Yang
- Department of Gastrointestinal Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Wen
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Pei-Wu Yu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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Short-Term Surgical Outcomes of Robotic Gastrectomy Compared to Open Gastrectomy for Patients with Gastric Cancer: a Randomized Trial. J Gastrointest Surg 2022; 26:2477-2485. [PMID: 36127557 DOI: 10.1007/s11605-022-05448-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/13/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Robotic gastrectomy (RG) has been shown to be a safe and feasible method in gastric cancer (GC) treatment. However, most studies are in Eastern cohorts and there is great interest in knowing whether the method can be used routinely, especially in the West. OBJECTIVES The aim of this study was to compare the short-term surgical outcomes of D2-gastrectomy by RG versus open gastrectomy (OG). METHODS Single-institution, open-label, non-inferiority, randomized clinical trial performed between 2015 and 2020. GC patients were randomized (1:1 allocation) to surgical treatment by RG or OG. Da Vinci Si platform was used. INCLUSION CRITERIA gastric adenocarcinoma, stage cT2-4 cN0-1, potentially curative surgery, age 18-80 years, and ECOG performance status 0-1. EXCLUSION CRITERIA emergency surgery and previous gastric or major abdominal surgery. Primary endpoint was short-term surgical outcomes. The study is registered at clinicaltrials.gov (NCT02292914). RESULTS Of 65 randomized patients, 5 were excluded (3 palliatives, 1 obstruction and emergency surgery, and 1 for material shortage). Consequently, 31 and 29 patients were included for final analysis in the OG and RG groups, respectively. No differences were observed between groups regarding age, sex, BMI, comorbidities, ASA, and frequency of total gastrectomy. RG had similar mean number of harvested lymph nodes (p = 0.805), longer surgical time (p < 0.001), and less bleeding (p < 0.001) compared to OG. Postoperative complications, length of hospital stay, and readmissions in 30 days were equivalent between OG and RG. CONCLUSIONS RG reduces operative bleeding by more than 50%. The short-term outcomes were non-inferior to OG, although surgical time was longer in RG.
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Di Carlo S, Siragusa L, Fassari A, Fiori E, La Rovere F, Izzo P, Usai V, Cavallaro G, Franceschilli M, Dhimolea S, Sibio S. Laparoscopic versus Open Total Gastrectomy for Locally Advanced Gastric Cancer: Short and Long-Term Results. Curr Oncol 2022; 29:8442-8455. [PMID: 36354725 PMCID: PMC9689079 DOI: 10.3390/curroncol29110665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy for early gastric cancer is widely accepted and routinely performed. However, it is still debated whether the laparoscopic approach is a valid alternative to open gastrectomy in advanced gastric cancer (AGC). The aim of this study is to compare short-and long-term outcomes of laparoscopic (LG) and open (OG) total gastrectomy with D2 lymphadenectomy in patients with AGC. METHODS A retrospective comparative study was conducted on patients who underwent LG and OG for ACG between January 2015 and December 2021. Primary endpoints were the following: recurrence rate, 3-year disease-free survival, 3-year and 5-year overall survival. Univariate and multivariate analysis was conducted to compare variables influencing outcomes and survival. RESULTS Ninety-two patients included: fifty-three OG and thirty-nine LG. No difference in morbidity and mortality. LG was associated with lower recurrence rates (OG 22.6% versus LG 12.8%, p = 0.048). No differences in 3-year and 5-year overall survival; 3-year disease-free survival was improved in the LG group on the univariate analysis but not after the multivariate one. LG was associated with longer operative time, lower blood loss and shorter hospital stay. Lymph node yield was higher in LG. CONCLUSION LG for AGC seems to provide satisfactory clinical and oncological outcomes in medium volume centers, improved postoperative results and possibly lower recurrence rates.
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Affiliation(s)
- Sara Di Carlo
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Alessia Fassari
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Enrico Fiori
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca La Rovere
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Valeria Usai
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marzia Franceschilli
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
- Correspondence:
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Chen P, Zhou H, Chen C, Qian X, Yang L, Zhou Z. Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies. Front Surg 2022; 9:1006717. [DOI: 10.3389/fsurg.2022.1006717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTo evaluate short- and long-term outcomes of laparoscopic colectomy (LC) vs. open colectomy (OC) in patients with T4 colon cancer.MethodsThree authors independently searched PubMed, Web of Science, Embase, Cochrane Library, and Clinicaltrials.gov for articles before June 3, 2022 to compare the clinical outcomes of T4 colon cancer patients undergoing LC or OC.ResultsThis meta-analysis included 7 articles with 1,635 cases. Compared with OC, LC had lesser blood loss, lesser perioperative transfusion, lesser complications, lesser wound infection, and shorter length of hospital stay. Moreover, there was no significant difference between the two groups in terms of 5-year overall survival (5y OS), and 5-year disease-free survival (5y DFS), R0 resection rate, positive resection margin, lymph nodes harvested ≥12, and recurrence. Trial Sequential Analysis (TSA) results suggested that the potential advantages of LC on perioperative transfusion and the comparable oncological outcomes in terms of 5y OS, 5y DFS, lymph nodes harvested ≥12, and R0 resection rate was reliable and no need of further study.ConclusionsLaparoscopic surgery is safe and feasible in T4 colon cancer in terms of short- and long-term outcomes. TSA results suggested that future studies were not required to evaluate the 5y OS, 5y DFS, R0 resection rate, positive resection margin status, lymph nodes harvested ≥12 and perioperative transfusion differences between LC and OC.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297792.
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Wang ZK, Lin JX, Wang FH, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Li P, Zheng CH, Huang CM. Robotic spleen-preserving total gastrectomy shows better short-term advantages: a comparative study with laparoscopic surgery. Surg Endosc 2022; 36:8639-8650. [PMID: 35697854 DOI: 10.1007/s00464-022-09352-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Robotic surgery may be advantageous for complex surgery. We aimed to compare the intraoperative and postoperative short-term outcomes of spleen-preserving splenic hilar lymphadenectomy (SPSHL) during robotic and laparoscopic total gastrectomy. METHODS From July 2016 to December 2020, the clinicopathological data of 115 patients who underwent robotic total gastrectomy combined with robotic SPSHL (RSPSHL) and 697 patients who underwent laparoscopic total gastrectomy combined with laparoscopic SPSHL (LSPSHL) were retrospectively analyzed. A 1:2 ratio propensity score matching (PSM) was used to balance the differences between the two groups to compare their outcomes. The Generic Error Rating Tool was used to evaluate the technical performance. RESULTS After PSM, the baseline preoperative characteristics of the 115 patients in the RSPSHL and 230 patients in the LSPSHL groups were balanced. The dissection time of the region of the splenic artery trunk (5.4 ± 1.9 min vs. 7.8 ± 3.6 min, P < 0.001), the estimated blood loss during SPSHL (9.6 ± 4.8 ml vs. 14.9 ± 7.8 ml, P < 0.001), and the average number of intraoperative technical errors during SPSHL (15.1 ± 3.4 times/case vs. 20.7 ± 4.3 times/case, P < 0.001) were significantly lower in the RSPSHL group than in the LSPSHL group. The RSPSHL group showed higher dissection rates of No. 10 (78.3% vs. 70.0%, P = 0.104) and No. 11d (54.8% vs. 40.4%, P = 0.012) lymph nodes and significantly improved postoperative recovery results in terms of times to ambulation, first flatus, and first intake (P < 0.05). The splenectomy rates of the two groups were similar (1.7% vs. 0.4%, P = 0.539), and there was no significant difference in morbidity and mortality within postoperative 30 days (13.0% vs. 15.2%, P = 0.589). CONCLUSION Compared to LSPSHL, RSPSHL has more advantages in terms of surgical qualities and postoperative recovery process with similar morbidity and mortality. For complex SPSHL, robotic surgery may be a better choice.
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Affiliation(s)
- Zu-Kai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Fu-Hai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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Gao G, Liao H, Jiang Q, Liu D, Li T. Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients. World J Surg Oncol 2022; 20:315. [PMID: 36171631 PMCID: PMC9520837 DOI: 10.1186/s12957-022-02778-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies on surgical outcomes after robotic surgery are increasing; however, long-term oncological results of studies comparing robotic-assisted distal gastrectomy (RADG) versus laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC) are still limited. This study aimed to assess the surgical and oncological outcomes of RADG and LADG for the treatment of AGC. METHODS A total of 1164 consecutive AGC patients undergoing RADG or LADG were enrolled between January 2015 and October 2021. Propensity score-matched (PSM) analysis was performed to minimize selection bias. The perioperative and oncological outcomes between the two groups were compared. RESULTS Patient's characteristics were comparable between the two groups after PSM. RADG group represented a longer operative time (205.2 ± 43.1 vs 185.3 ± 42.8 min, P < 0.001), less operative blood loss (139.3 ± 97.8 vs 167.3 ± 134.2 ml, P < 0.001), greater retrieved lymph nodes (LNs) number (31.4 ± 12.1 vs 29.4 ± 12.3, P = 0.015), more retrieved LNs in the supra-pancreatic areas (13.4 ± 5.0 vs 11.4 ± 5.1, P < 0.001), and higher medical costs (13,608 ± 4326 vs 10,925 ± US $3925, P < 0.001) than LADG group. The overall complication rate was 13.7% in the RADG group and 16.6% in the LADG group, respectively; the difference was not significantly different (P = 0.242). In the subgroup analysis, the benefits of RADG were more evident in high BMI patients. Moreover, the 3-year overall survival (75.5% vs 73.1%, P = 0.471) and 3-year disease-free survival (72.9% vs 71.4%, P = 0.763) were similar between the two groups. CONCLUSION RADG appears to be a safe and feasible procedure and could serve as an alternative treatment for AGC in experienced centers.
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Affiliation(s)
- Gengmei Gao
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China.,Department of Graduate School, Medical College of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Hualin Liao
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China.,Department of Graduate School, Medical College of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Qunguang Jiang
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Dongning Liu
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Taiyuan Li
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China. .,Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
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Jeong SA, Lee IS. Current status of robotic gastrectomy for gastric cancer: A review of recent randomized controlled trials. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seong-A Jeong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Seob Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Omori T, Yamamoto K, Hara H, Shinno N, Yamamoto M, Fujita K, Kanemura T, Takeoka T, Akita H, Wada H, Yasui M, Matsuda C, Nishimura J, Fujiwara Y, Miyata H, Ohue M, Sakon M. Comparison of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 2022; 36:6223-6234. [DOI: 10.1007/s00464-022-09125-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/07/2022] [Indexed: 02/06/2023]
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Comparisons of surgical outcomes between robotic and laparoscopic total gastrectomy in patients with clinical stage I/IIA gastric cancer. Surg Endosc 2022; 36:5257-5266. [PMID: 34997341 DOI: 10.1007/s00464-021-08903-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The robotic approach is especially promising for challenging surgeries, such as total gastrectomy. However, it remains unclear whether robotic total gastrectomy (RTG) is superior to conventional laparoscopic total gastrectomy (LTG). The present study aimed to clarify the impact of RTG on short- and long-term outcomes for patients with clinical stage I/IIA gastric cancer. METHODS This study included 98 patients with clinical stage I/IIA gastric cancer who underwent minimally invasive total gastrectomy from October 2013 to December 2020 at the Shizuoka Cancer Center. The short- and long-term outcomes of RTG were compared with those of LTG. RESULTS This study included 36 RTG and 58 LTG patients. RTG was associated with a significantly longer operative time than LTG (p = 0.023). All complications tended to be lower in the RTG group than in the LTG group (2.8% and 15.5%, respectively; p = 0.083). There were no patients with anastomotic leakage in the RTG group. The multivariate analysis identified LTG as the only independent risk factor for postoperative complications (odds ratio, 6.620; 95% confidence interval, 1.132-126.4; p = 0.034). The survival of the RTG and LTG groups was equivalent. CONCLUSIONS RTG reduced the risk of complications compared to LTG. Patients treated using the two approaches showed equivalent survival.
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Li ZY, Liu JJ, Yu PW, Zhao YL, Shi Y, Luo ZY, Wu B, Wang JJ, Qian F. Robotic total gastrectomy for carcinoma in the remnant stomach: a comparison with laparoscopic total gastrectomy. Gastroenterol Rep (Oxf) 2021; 9:583-588. [PMID: 34925855 PMCID: PMC8677512 DOI: 10.1093/gastro/goab021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/16/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Total gastrectomy for carcinoma in the remnant stomach (CRS) remains a technically demanding procedure. Whether robotic surgery is superior, equal, or inferior to laparoscopic surgery in patients with CRS is unclear. This study was designed to compare the efficacy and safety of robotic total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) for the treatment of CRS. Methods In this cohort study, we retrospectively analysed the data from patients who underwent RTG or LTG for CRS at Southwest Hospital (Chongqing, China) between May 2006 and October 2019. The surgical outcomes, post-operative complications, and survival outcomes between the two groups were compared. Results Compared with LTG, RTG was associated with similar effective operation time (272.0 vs 297.9 min, P = 0.170), higher total costs (105,967.2 vs 81,629.5 RMB, P < 0.001), and less estimated blood loss (229.2 vs 288.8 mL, P = 0.031). No significant differences were found between the robotic and laparoscopic groups in terms of conversion rate, time to first flatus, time to first soft diet, post-operative hospital stay, post-operative complications, R0 resection rate, and number of retrieved lymph nodes (all P > 0.05). The 3-year disease-free survival and 3-year overall survival rates were comparable between the two groups (65.5% vs 57.5%, P = 0.918; 69.0% vs 60.0%, P = 0.850, respectively). Conclusions RTG is a safe and feasible procedure for the treatment of CRS and could serve as an optimal treatment for CRS.
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Affiliation(s)
- Zheng-Yan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Jia-Jia Liu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Pei-Wu Yu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Yong-Liang Zhao
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Yan Shi
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Zi-Yan Luo
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Bin Wu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Jun-Jie Wang
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Feng Qian
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
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Kamarajah SK, Griffiths EA, Phillips AW, Ruurda J, van Hillegersberg R, Hofstetter WL, Markar SR. Robotic Techniques in Esophagogastric Cancer Surgery: An Assessment of Short- and Long-Term Clinical Outcomes. Ann Surg Oncol 2021; 29:2812-2825. [PMID: 34890023 PMCID: PMC8989809 DOI: 10.1245/s10434-021-11082-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022]
Abstract
Background Robotic esophagogastric cancer surgery is gaining widespread adoption. This population-based cohort study aimed to compare rates of textbook outcomes (TOs) and survival from robotic minimally invasive techniques for esophagogastric cancer. Methods Data from the United States National Cancer Database (NCDB) (2010–2017) were used to identify patients with non-metastatic esophageal or gastric cancer receiving open surgery (to the esophagus, n = 11,442; stomach, n = 22,183), laparoscopic surgery (to the esophagus [LAMIE], n = 4827; stomach [LAMIG], n = 6359), or robotic surgery (to the esophagus [RAMIE], n = 1657; stomach [RAMIG], n = 1718). The study defined TOs as 15 or more lymph nodes examined, margin-negative resections, hospital stay less than 21 days, no 30-day readmissions, and no 90-day mortalities. Multivariable logistic regression and Cox analyses were used to account for treatment selection bias. Results Patients receiving robotic surgery were more commonly treated in high-volume academic centers with advanced clinical T and N stage disease. From 2010 to 2017, TO rates increased for esophageal and gastric cancer treated via all surgical techniques. Compared with open surgery, significantly higher TO rates were associated with RAMIE (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.27–1.58) and RAMIG (OR 1.30; 95% CI 1.17–1.45). For esophagectomy, long-term survival was associated with both TO (hazard ratio [HR 0.64, 95% CI 0.60–0.67) and RAMIE (HR 0.92; 95% CI 0.84–1.00). For gastrectomy, long-term survival was associated with TO (HR 0.58; 95% CI 0.56–0.60) and both LAMIG (HR 0.89; 95% CI 0.85–0.94) and RAMIG (HR 0.88; 95% CI 0.81–0.96). Subset analysis in high-volume centers confirmed similar findings. Conclusion Despite potentially adverse learning curve effects and more advanced tumor stages captured during the study period, both RAMIE and RAMIG performed in mostly high-volume centers were associated with improved TO and long-term survival. Therefore, consideration for wider adoption but a well-designed phase 3 randomized controlled trial (RCT) is required for a full evaluation of the benefits conferred by robotic techniques for esophageal and gastric cancers. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-11082-y.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alexander W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle Upon Tyne, UK.,School of Medical Education, Newcastle University, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Jelle Ruurda
- University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | | | - Wayne L Hofstetter
- Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Hu Y, Yoon SS. Extent of gastrectomy and lymphadenectomy for gastric adenocarcinoma. Surg Oncol 2021; 40:101689. [PMID: 34839198 DOI: 10.1016/j.suronc.2021.101689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 12/18/2022]
Abstract
Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well-established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This chapter outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed.
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Affiliation(s)
- Yinin Hu
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, MD, USA.
| | - Sam S Yoon
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Rodriguez MJ, Ore AS, Schawkat K, Kennedy K, Bullock A, Pleskow DK, Critchlow J, Moser AJ. Treatment burden of robotic gastrectomy for locally advanced gastric cancer (LAGC): a single western experience. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1408. [PMID: 34733960 PMCID: PMC8506707 DOI: 10.21037/atm-21-1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022]
Abstract
Background This study compares standard of care (SOC) open and robotic D2-gastrectomy for locally advanced gastric cancer (LAGC) in the Western context of low disease prevalence, reduced surgical volume, and neoadjuvant chemotherapy (NAC). We hypothesized that robotic gastrectomy (RG) after NAC reduces treatment burden for LAGC across multiple outcome domains vs. SOC. Methods Single institution, interrupted time series comparing SOC (2008–2013) for LAGC (T2–4Nany/TanyN+) vs. NAC + RG (2013–2018). Treatment burden was a composite metric of narcotic consumption, oncologic efficacy, cumulative morbidity, and 90-day resource utilization. Predictors were evaluated via multivariate modeling. Learning curve analysis was done using CUSUM. Results After exclusions, 87 subjects with equivalent baseline characteristics, aside from male sex, were treated via SOC (n=55) or NAC + RG (n=32). All four domains of treatment burden were significantly reduced in the NAC + RG cohort compared to SOC (P=0.003). The odds ratio for excess treatment burden in the NAC/RG was 0.23 (95% CI: 0.07–0.72, P=0.0117) vs. SOC upon multivariable modeling, whereas the extent of resection (total/subtotal), tumor size, T-stage, sex, and early learning curve had no effect. Differences in treatment burden persisted in subgroup analysis for NAC (n=51). Conclusions NAC + RG was associated with decreased treatment burden relative to SOC for LAGC. Frequencies of unfavorable hospitalization, adverse oncological outcomes, major morbidity, and narcotic consumption all decreased in this interrupted time series.
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Affiliation(s)
- M Juanita Rodriguez
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ana Sofia Ore
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Khoschy Schawkat
- Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zürich, Zürich, Switzerland
| | - Kevin Kennedy
- Biostatistics, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Andrea Bullock
- Medical Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Douglas K Pleskow
- Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Jonathan Critchlow
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - A James Moser
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Park SH, Kim JM, Park SS. Current Status and Trends of Minimally Invasive Gastrectomy in Korea. Medicina (B Aires) 2021; 57:medicina57111195. [PMID: 34833413 PMCID: PMC8621245 DOI: 10.3390/medicina57111195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Since its introduction in the early 1990s, laparoscopic gastrectomy has been widely accepted for the treatment of gastric cancer worldwide. In the last decade, the Korean Laparoendoscopic Gastrointestinal Surgery Study group performed important clinical trials and exerted various efforts to enhance the quality of scientific knowledge and surgical techniques in the field of gastric cancer surgery. Laparoscopic gastrectomy has shifted to a new era in Korea due to recent advances and innovations in technology. Here, we discuss the recent updates of laparoscopic gastrectomy—namely, reduced-port, single-incision, robotic, image-guided, and oncometabolic surgery.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
| | - Jong-Min Kim
- Department of Surgery, Min General Surgery Hospital, 155 Dobong-ro, Gangbuk-gu, Seoul 01171, Korea;
| | - Sung-Soo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
- Correspondence: or ; Tel.: +82-2-920-6772; Fax: +82-2-928-1631
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Comparison of short-term outcomes of robotic-assisted and laparoscopic-assisted D2 gastrectomy for gastric cancer: a meta-analysis. Wideochir Inne Tech Maloinwazyjne 2021; 16:443-454. [PMID: 34691296 PMCID: PMC8512504 DOI: 10.5114/wiitm.2021.105731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Aim The aim of the study was to compare the outcomes of robot-assisted (RAGD2) and laparoscopy-assisted gastrectomy with D2 lymphadenectomy (LAGD2) for patients with gastric cancer. Material and methods Relevant articles published up to September 2020 were searched. The weighted mean difference (WMD) was used to pool continuous variables, while risk ratio (RR) was calculated for dichotomous outcomes. Results RAGD2 required a longer operating time (WMD = 29.78, 95% confidence interval (CI): 15.97-43.59) and had less operative blood loss (WMD = -31.93, 95% CI: -44.03 to -19.83), shorter time to first flatus (WMD = -0.13, 95% CI: -0.22 to -0.04), shorter time to liquid diet (WMD = -0.20, 95% CI: -0.28 to 0.12), and fewer severe complications (RR = 0.62, 95% CI: 0.43-0.90) and overall complications (RR = 0.75, 95% CI: 0.62-0.91) than LAGD2. Conclusions RAGD2 could be beneficial in reducing operative blood loss and postoperative complications relative to LAGD2.
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Effectiveness and safety of robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis of 12,401 gastric cancer patients. Updates Surg 2021; 74:267-281. [PMID: 34655427 DOI: 10.1007/s13304-021-01176-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/19/2021] [Indexed: 02/05/2023]
Abstract
Advanced minimally invasive techniques, such as robotic surgeries, are applied increasingly frequently around the world and are primarily used to improve the surgical outcomes of laparoscopic gastrectomy (LG). Against that background, we conducted a meta-analysis to evaluate the feasibility, safety, and effectiveness of robotic gastrectomy (RG). Studies comparing surgical outcomes between LG and RG patients were retrieved from medical databases, including RCTs and non-RCTs. The primary outcome of this study was overall survival, which was obtained by evaluating the 3-year survival rate and the 5-year survival rate. In addition, postoperative complications, mortality, length of hospital stay, and harvested lymph nodes were also assessed. We also conducted subgroup analyses stratified by resection type, body mass index, age, depth of invasion and tumour size. Ultimately, 31 articles met the criterion for our study through an attentive check of each text, including 1 RCT and 30 non-RCTs. A total of 12,401 patients were included in the analysis, with 8127 (65.5%) undergoing LG and 4274 (34.5%) undergoing RG. Compared with LG, RG was associated with fewer postoperative complications (OR 0.81; 95% CI 0.71-0.93; P = 0.002), especially pancreas-related complications (OR 0.376; 95% CI 0.156-0.911; P = 0.030), increased harvested lymph nodes (WMD 2.03; 95% CI 0.95-3.10; P < 0.001), earlier time to first flatus (WMD - 0.105 days; 95% CI - 0.207 to - 0.003; P = 0.044), longer operation time (WMD 40.192 min, 95% CI 32.07-48.31; P < 0.001), less intraoperative blood loss (WMD - 20.09 ml; 95% CI - 26.86 to - 13.32; P < 0.001), and higher expense (WMD 19,141.68 RMB; 95% CI 11,856.07-26,427.29; P < 0.001). There was no significant difference between RG and LG regarding 3-year overall survival (OR 1.030; 95% CI 0.784-1.353; P = 0.832), 5-year overall survival (OR 0.862; 95% CI 0.721-1.031; P = 0.105), conversion rate (OR 0.857; 95% CI 0.443-1.661; P = 0.648), postoperative hospital stay (WMD - 0.368 days; 95% CI - 0.75-0.013; P = 0.059), mortality (OR 1.248; 95% CI 0.514-3.209; P = 0.592), and reoperation (OR 0.855; 95% CI 0.479-1.525; P = 0.595). Our study revealed that postoperative complications, especially pancreas-related complications, occurred less often with RG than with LG. However, long-term outcomes between the two surgical techniques need to be further examined, particularly regarding the oncological adequacy of robotic gastric cancer resections.
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Li ZY, Zhao YL, Qian F, Tang B, Luo ZY, Wen Y, Shi Y, Yu PW. Comparison of the Postoperative Complications Between Robotic Total and Distal Gastrectomies for Gastric Cancer Using Clavien-Dindo Classification: A Propensity Score-matched Retrospective Cohort Study of 726 Patients. Surg Innov 2021; 29:608-615. [PMID: 34549638 DOI: 10.1177/15533506211047011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study was designed to compare the postoperative complications after Robotic total gastrectomy (RTG) and robotic distal gastrectomy (RDG) and to systematically evaluate the safety and feasibility of RTG for the treatment of gastric cancer (GC). METHODS Patients with GC who underwent RTG or RDG for curative intent between March 2010 and August 2019 were analyzed. We used propensity score matching (PSM) to reduce selection bias. The morbidity and mortality within 30 days after surgery between the RTG and the RDG groups were compared. RESULTS According to Clavien-Dindo (C-D) classification, the morbidity and mortality of the RTG group were comparable to those of the RDG group. Subgroup analyses showed no significant difference between the RTG and RDG groups in all stratified parameters (all P > .05). Multivariate analysis revealed that age ≥70 years (P = .002) and surgeons' experience ≤25 cases (P = .013) were independent risk factors for overall complication. Surgeons' experience ≤25 cases (P = .010) was identified as an independent risk factor for severe complication. CONCLUSION RTG is a safe and feasible surgical procedure for the treatment of GC with acceptable morbidity and mortality. More complications were observed for RTG, indicating that RTG is more invasive than RDG.
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Affiliation(s)
- Zheng-Yan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
| | - Feng Qian
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
| | - Bo Tang
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
| | - Zi-Yan Luo
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
| | - Yan Wen
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
| | - Pei-Wu Yu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, 12525Third Military Medical University, Chongqing, China
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Giuliani G, Guerra F, De Franco L, Salvischiani L, Benigni R, Coratti A. Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer. J Pers Med 2021; 11:638. [PMID: 34357105 PMCID: PMC8306865 DOI: 10.3390/jpm11070638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical practice is still uncertain. We aimed to critically review the relevant evidence comparing robotic to standard laparoscopic surgery in performing radical gastrectomy. METHODS The Pubmed/Medline electronic databases were searched through February 2021. Paper conference and the English language was the only restriction applied to our search strategy. RESULTS According to the existing data, robotic gastrectomy seems to provide some benefits in terms of blood loss, rate of conversion, procedure-specific postoperative morbidity, and length of hospital stay. Robotic gastrectomy is also associated with a longer duration of surgery and a higher economic burden as compared to its laparoscopic counterpart. No significant differences have been disclosed in terms of long-term survivals, while the number of lymph nodes retrieved with robotic gastrectomy is generally higher than that of laparoscopy. CONCLUSIONS The current literature suggests that robotic radical gastrectomy appears as competent as the conventional laparoscopic procedure and may provide some clinical advantages. However, due to the relative paucity of high-level evidence, it is not possible to draw definitive conclusions.
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Affiliation(s)
- Giuseppe Giuliani
- USL Toscana Sud Est, Misericordia Hospital, 58100 Grosseto, Italy; (F.G.); (L.D.F.); (L.S.); (R.B.); (A.C.)
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Shin HJ, Son SY, Wang B, Roh CK, Hur H, Han SU. Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Propensity Score-weighted Analysis of 2084 Consecutive Patients. Ann Surg 2021; 274:128-137. [PMID: 32187032 DOI: 10.1097/sla.0000000000003845] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias. SUMMARY OF BACKGROUND DATA Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG). METHODS Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model. RESULTS After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P = 0.498). CONCLUSIONS After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.
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Affiliation(s)
- Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Department of Transplantation and Vascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Bo Wang
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Chul Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
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Robotic versus laparoscopic gastrectomy for gastric cancer: an umbrella review of systematic reviews and meta-analyses. Updates Surg 2021; 73:1673-1689. [PMID: 34031848 PMCID: PMC8500879 DOI: 10.1007/s13304-021-01059-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
An umbrella review was performed to summarize literature data and to investigate benefits and harm of robotic gastrectomy (RG) compared to laparoscopic (LG) approach. To overcome the intrinsic limitations of laparoscopy, the robotic approach is claimed to facilitate lymph-node dissection and complex reconstruction after gastrectomy, to assure oncologic safety also in advanced gastric cancer. A literature search was conducted in PubMed, Cochrane and Embase databases for all meta-analyses published up to December 2019. The search strategy was previously published in a protocol. We selected fourteen meta-analyses comparing outcomes between LG and RG with curative intent in patients with diagnosis of resectable gastric cancer. We highlight that RG has a longer operation time, inferior blood loss, reduction in hospital stay and a more rapid recovery of bowel function. In meta-analyses with statistical significance the number of nodes removed in RG is higher than LG and the distal margin of resection is higher. There is no difference in terms of total complication rate, mortality, morbidity, anastomotic leakage, anastomotic stenosis, intestinal obstruction and in conversion rate to open technique. The safety and efficacy of robotic gastrectomy are not clearly supported by strong evidence, suggesting that the outcomes reported for each surgical technique need to be interpreted with caution, in particular for the meta-analyses in which the heterogeneity is large. Certainly, robotic gastrectomy is associated with shorter time to oral intake, lesser intraoperative bleeding and longer operation time with an acceptable level of evidence. On the other hand, the data regarding other outcomes are insufficient as well as non-significant, from an evidence point of view, to draw any robust conclusion.
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Barchi LC, Ramos MFKP, Dias AR, Forones NM, Carvalho MPD, Castro OAP, Kassab P, Costa-Júnior WLD, Weston AC, Zilberstein B, Ferraz ÁAB, ZeideCharruf A, Brandalise A, Silva AMD, Alves B, Marins CAM, Malheiros CA, Leite CV, Bresciani CJC, Szor D, Mucerino DR, Wohnrath DR, JirjossIlias E, Martins Filho ED, PinatelLopasso F, Coimbra FJF, Felippe FEC, Tomasisch FDS, Takeda FR, Ishak G, Laporte GA, Silva HJT, Cecconello I, Rodrigues JJG, Grande JCD, Lourenço LG, Motta LMD, Ferraz LR, Moreira LF, Lopes LR, Toneto MG, Mester M, Rodrigues MAG, Franciss MY, AdamiAndreollo N, Corletta OC, Yagi OK, Malafaia O, Assumpção PP, Savassi-Rocha PR, Colleoni Neto R, Oliveira RJD, AissarSallun RA, Weschenfelder R, Oliveira SCVD, Abreu TBD, Castria TBD, Ribeiro Junior U, Barra W, Freitas Júnior WRD. BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 2): UPDATE ON TREATMENT. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 34:e1563. [PMID: 34008707 PMCID: PMC8121052 DOI: 10.1590/0102-672020210001e1563] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. AIM : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. METHODS To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. CONCLUSION : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.
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Affiliation(s)
- Leandro Cardoso Barchi
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Faculty of Medicine São Leopoldo Mandic, Campinas, SP, Brazil
| | | | - André Roncon Dias
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Paulo Kassab
- Department of Surgery, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Wilson Luiz da Costa-Júnior
- Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, SP, Brazil
- Department of Medicine, Baylor College of Medicine, Houston,Texas
| | | | - Bruno Zilberstein
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Faculty of Medicine São Leopoldo Mandic, Campinas, SP, Brazil
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Terashima M. The 140 years' journey of gastric cancer surgery: From the two hands of Billroth to the multiple hands of the robot. Ann Gastroenterol Surg 2021; 5:270-277. [PMID: 34095716 PMCID: PMC8164465 DOI: 10.1002/ags3.12442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/18/2022] Open
Abstract
After the initial achievement by Billroth in 1881, surgery for gastric cancer has become increasingly extended. However, it turned out to be limited in Western countries after the publication that denied the role of extended surgery in the 1960s. While surgeons in Japan were still enthusiastic about extended surgery, the Japan Clinical Oncology Group (JCOG) conducted clinical trials to validate the role of extended surgery. Contrary to expectations, the efficacy of extended surgery was not demonstrated. In gastric cancer surgery, postoperative complications were reported to be associated with poor survival. A survival benefit could not be obtained by extended surgery, with high morbidity. Therefore, the paradigm had been changed from extended surgery to minimally invasive surgery (MIS). As an MIS for gastric cancer, laparoscopic surgery has been considered a practical method. Initial laparoscopic gastrectomy (LG) was first performed by Kitano in 1991. Thereafter, LG became increasingly common. Several clinical trials demonstrated the noninferiority of LG to open gastrectomy. LG is now regarded as the standard for cStage I gastric cancer, and the indication is expanding to advanced cancer. However, LG has some drawbacks owing to the restriction of movement caused by straight-shaped forceps. Robotic gastrectomy (RG) is considered a major breakthrough to circumvent the drawbacks in LG using articulated devices. However, the solid evidence demonstrating the advantage of RG has not been proved yet. The JCOG is now conducting a randomized controlled trial to evaluate the superiority of RG to LG in terms of reducing morbidity.
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Lu J, Zheng CH, Xu BB, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Huang CM, Li P. Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. Ann Surg 2021; 273:858-867. [PMID: 32889876 DOI: 10.1097/sla.0000000000004466] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the short-term outcomes of patients with GC who received RDG or LDG. SUMMARY BACKGROUND DATA Despite the increasing use of RDG in patients with GC, its safety and efficacy compared to those of LDG have not been elucidated in a randomized controlled trial. METHODS Three hundred patients with cT1-4a and N0/+ between September 2017 and January 2020 were enrolled in this randomized controlled trial at a high-volume hospital in China. The short-term outcomes were compared between the groups. RESULTS The modified intention-to-treat analysis included data from 283 patients (RDG group: n = 141) and (LDG group: n = 142). Patients in the RDG group exhibited faster postoperative recovery, milder inflammatory responses, and reduced postoperative morbidity (9.2% vs 17.6%, respectively, P = 0.039). Higher extraperigastric lymph nodes (LNs) were retrieved in the RDG group (17.6 ± 5.8 vs 15.8 ± 6.6, P = 0.018) with lower noncompliance rate (7.7% vs 16.9%, respectively, P = 0.006). Additionally, patients in the RDG group were more likely to initiate adjuvant chemotherapy earlier [median (interquartile range) postoperative days: 28 (24-32) vs 32 (26-42), P = 0.003]. Although total hospital costs were higher in the robotic group than in the laparoscopic group, the direct cost was lower for RDG than for LDG (all P < 0.001). CONCLUSIONS RDG is associated with a lower morbidity rate, faster recovery, milder inflammatory responses, and improved lymphadenectomy. Additionally, faster postoperative recovery in the RDG group enables early initiation of adjuvant chemotherapy. Our results provide evidence for the application of RDG in patients with GC.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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Ebihara Y, Kurashima Y, Murakami S, Shichinohe T, Hirano S. Robotic Distal Gastrectomy With a Novel "Preemptive Retropancreatic Approach" During Dissection of Suprapancreatic Lymph Nodes for Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2021; 31:457-461. [PMID: 33900223 DOI: 10.1097/sle.0000000000000897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Abrogating contact with the pancreas in suprapancreatic lymph nodes dissection for gastric cancer can prevent pancreatic fistula because of postoperative pancreatic damage. Our novel "Preemptive retropancreatic approach" is a useful technique that minimizes pancreatic compression during robotic distal gastrectomy (RDG) with multijointed forceps. Here, we report the usefulness of RDG for gastric cancer surgery using our novel "Preemptive retropancreatic approach". MATERIALS "Preemptive retropancreatic approach": initial dissection of the bilateral retropancreatic space, the adherence between the retroperitoneum surface and the pancreas (fusion fascia) is released, providing a good operative field and hindering contact with the pancreas in suprapancreatic lymph nodes dissection during RDG. We herein reported consecutive 30 patients with gastric cancer who underwent RDG at Hokkaido University from September 2014 to March 2020. RESULTS All operations were performed by a single surgeon (Y.E.). The median operating time was 281 minutes (132 to 415). The median intraoperative bleeding was 0 ml of blood (0 to 255). There were 2 incidences of postoperative complications (≥Clavien-Dindo classification II), and there were no cases of postoperative pancreas-related complications. The median length of hospital stay after the surgery was 10 days (6 to 33). CONCLUSION As RDG for gastric cancer is still in its early introductory phase, its superiority has yet to be definitively established. However, we believe that "Preemptive retropancreatic approach" may reduce postoperative pancreatic-related complications in suprapancreatic lymph nodes dissection.
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Affiliation(s)
- Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine
- Division of Minimally Invasive Surgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine
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Kinoshita T, Sato R, Akimoto E, Tanaka Y, Okayama T, Habu T. Reduction in postoperative complications by robotic surgery: a case-control study of robotic versus conventional laparoscopic surgery for gastric cancer. Surg Endosc 2021; 36:1989-1998. [PMID: 33844086 PMCID: PMC8847173 DOI: 10.1007/s00464-021-08483-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/28/2021] [Indexed: 12/19/2022]
Abstract
Background Robotic gastrectomy (RG) is being increasingly performed globally; it is considered an evolved type of conventional laparoscopic surgery with excellent dexterity and precision, but higher costs and longer operation time. Thus, there is a need to identify the benefits from RG and its specific candidates. Methods This retrospective study analyzed data from a prospectively collected clinical database at our center. Data of patients with primary gastric cancer undergoing either robotic or laparoscopic radical gastrectomy from June 2014 to June 2020 were reviewed. Surgical outcomes were compared between the two groups, and multivariable analyses were performed to elucidate the relevant factors for postoperative complications in several subgroups. Results A total of 1172 patients were divided into those who underwent RG (n = 152) and those who underwent laparoscopic gastrectomy (LG) (n = 1020). Baseline characteristics were similar in the two groups, except the RG group included more patients undergoing total/proximal gastrectomy (TG/PG) and patients at clinical stage III. Compared with the LG group, the RG group had lower incidences of postoperative complications ≥ Clavien-Dindo grade III (2/152 (1.3%) versus 72/1020 (7.1%); P = 0.004), and intraabdominal complications ≥ grade II (6/152 (3.9%) versus 119/1020 (11.7%); P = 0.004). Multivariable analysis revealed that RG was a significant relevant factor for reducing overall postoperative complications (≥ grade III) (odds ratio (OR) 0.16, P = 0.013), and intraabdominal complications (≥ grade II) (OR 0.29, P = 0.002). Subgroup analyses demonstrated that this tendency was enhanced in patients undergoing TG/PG (OR 0.29, P = 0.021) or at clinical stage II/III (OR 0.10, P = 0.027). Conclusions RG reduces the incidence of postoperative complications compared with conventional LG and this tendency may be enhanced in technically complicated procedures with demanding anastomosis or D2 lymphadenectomy. Patients requiring such procedures would most benefit from RG.
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Affiliation(s)
- Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.
| | - Reo Sato
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Eigo Akimoto
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yuya Tanaka
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Takafumi Okayama
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Takumi Habu
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
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Staderini F, Giudici F, Coratti F, Bisogni D, Cammelli F, Barbato G, Gatto C, Manetti F, Braccini G, Cianchi F. Robotic gastric surgery: a monocentric case series and review of the literature. Minerva Surg 2021; 76:116-123. [PMID: 33908237 DOI: 10.23736/s2724-5691.21.08769-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The technical complexity of D2 lymphadenectomy and esophago-jejunal anastomosis are the main factors that limit the application of laparoscopic surgery in the treatment of gastric cancer. Robotic assisted gastric surgery provides potential technical advantages over conventional laparoscopy but an improvement in clinical outcomes after robotic surgery has not been demonstrated yet. EVIDENCE ACQUISITION Data from 128 consecutive patients who had undergone robotic gastrectomy for gastric cancer at our center institution from April 2017 to June 2020 where retrospectively reviewed from a prospectively updated database. A narrative review was then carried out on PubMed, Embase and Scopus using the following keywords: "gastric cancer," "robotic surgery," "robotic gastrectomy" and "robotic gastric surgery". EVIDENCE SYNTHESIS Ninety-eight patients underwent robotic distal gastrectomy and 30 underwent robotic total gastrectomy. The mean value of estimated blood loss was 99.5 ml. No patients required conversion to laparoscopy or open surgery. The median number of retrieved lymph nodes was 42. No tumor involvement of the proximal or distal margin was found in any patient. The median time to first flatus and first oral feeding was on postoperative day 3 and 5, respectively. We registered 6 leakages (4.6%), namely, 1 duodenal stump leakage and 5 anastomotic leakages. No 30-day surgical related mortality was recorded. The median length of hospital stay was 10.5 days (range 4-37). CONCLUSIONS Published data and our experience suggest that the robotic approach for gastric cancer is safe and feasible with potential advantages over conventional laparoscopy.
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Affiliation(s)
- Fabio Staderini
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy -
| | - Francesco Giudici
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Coratti
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Damiano Bisogni
- Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy
| | - Francesca Cammelli
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Barbato
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Gatto
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federico Manetti
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni Braccini
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Nishi M, Shimada M, Yoshikawa K, Tokunaga T, Kashihara H, Takasu C, Yoshikawa M, Wada Y, Yoshimoto T, Nakasu C. Advantages of the Left-handed Ultrasonic Shears Technique for Robotic Gastrectomy. Surg Laparosc Endosc Percutan Tech 2021; 31:497-501. [PMID: 33710100 DOI: 10.1097/sle.0000000000000923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/29/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this study was to investigate advantages of the left-handed ultrasonic shears technique in robotic gastrectomy for gastric cancer. METHODS We retrospectively analyzed 67 consecutive gastric cancer patients who underwent robotic gastrectomy. Fifty-six patients underwent gastrectomy with the left-handed ultrasonic shears technique (the left hand group), and 11 patients underwent surgery with the conventional approach (the conventional group). Intraoperative and postoperative outcomes were compared between the 2 groups. RESULTS Operative blood loss, morbidity, and mortality were similar between the 2 groups. We observed a trend toward a shorter operation time and higher number of retrieved lymph nodes in the left hand group compared with the conventional group. Console time (docking-gastrectomy) in the left hand group was significantly shorter than in the conventional group (192.20 vs. 218.36 min, P<0.05). In robotic distal gastrectomy, both operation time and console time in the left hand group were significantly shorter than in the conventional group (276.10 vs. 354.80 min, 176.43 vs. 209.20 min, P<0.05 for both). The postoperative intra-abdominal infectious complication (Clavien Dindo≥1) rate in the left hand group was significantly lower than that in the conventional group (0% vs. 20%, P<0.05). CONCLUSIONS Use of the left-handed ultrasonic shears technique is safe and provides a technically superior operative environment with satisfactory postoperative results.
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Affiliation(s)
- Masaaki Nishi
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Japan
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Incidence and risk factors of postoperative complications after robotic gastrectomy for gastric cancer: an analysis of 817 cases based on 10-year experience in a large-scale center. Surg Endosc 2021; 35:7034-7041. [PMID: 33492501 DOI: 10.1007/s00464-020-08218-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In this study, we investigated the incidence and risk factors for postoperative complications after robotic gastrectomy (RG) in patients with gastric cancer. METHODS A total of 817 patients who underwent RG for gastric cancer between March 2010 and August 2019 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo classification, and possible risk factors were evaluated. RESULTS Among 817 patients who underwent RG, overall, severe, local and systemic complication rates were 13.8, 4.2, 7.0 and 6.9%, respectively. Multivariable analysis revealed that an age of 70 years or older (P < 0.001) and multiorgan resection (P = 0.031) were independent risk factors for the occurrence of overall complications. Multivariable analysis showed that an age of 70 years or older (P = 0.005) and surgeons' experience ≤ 25 cases (P = 0.004) were independent risk factors for severe complications. Regarding local complications, an age of 70 years or older (P < 0.001), multiorgan resection (P = 0.010) and surgeons' experience ≤ 25 cases (P = 0.005) were identified as independent risk factors. An age of 70 years or older (P < 0.001), a BMI of 25 or higher (P = 0.045) and the presence of comorbidity (P = 0.029) were identified as independent risk factors for systemic complications. CONCLUSIONS The present study demonstrated that RG is a safe and feasible procedure for the treatment of gastric cancer, and it has an acceptable postoperative morbidity. Elderly patients and insufficient surgeon experience were two major risk factors for the occurrence of complications following RG. We suggest that surgeons choose patients in good condition during their RG learning phase to reduce learning-associated morbidity.
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