Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: Comparison of surgical performance and short-term outcomes

摘要

Purpose: This study was designed to compare robot-assisted gastrectomy with laparoscopy-assisted gastrectomy in surgical performance and short-term clinical outcomes for gastric cancer and evaluate the safety and feasibility of robotic surgery. Methods: A retrospective database of patients who underwent robotic or laparoscopic gastrectomy for gastric cancer between March 2010 and May 2013 was examined. After screening, 514 patients who underwent gastrectomy for gastric cancer were enrolled in this study: 120 robotic and 394 laparoscopic surgery. Patient demographics, surgical performance, and short-term clinical outcomes were examined. Results: All operations were performed successfully. The clinicopathologic characteristics were similar between the two groups. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss (118.3 ± 55.8 vs. 137.6 ± 61.6 ml, P < 0.001), more lymph nodes dissection (34.6 ± 10.9 vs. 32.7 ± 11.2, P = 0.013), and longer operation time (234.8 ± 42.4 vs. 221.3 ± 44.8 min, P = 0.003). The survival rates were 90.2 % at 1 year, 78.1 % at 2 years, and 67.8 % at 3 years in the RAG group compared with 87.3 % at 1 year, 77.1 % at 2 years, and 69.9 % at 3 years in the LAG group. The difference in overall survival rate between the two groups was not statistically significant (P = 0.812). In view of lymph node involvement, the 3-year survival rates for patients with negative nodal metastasis were 84.4 % in the RAG group versus 82.6 % in the LAG group (P = 0.972) and 57.5 % in the RAG group versus 60.3 % in the LADG group (P = 0.653) for those with positive nodal metastasis. Conclusions: Comparing well with laparoscopic gastrectomy, robot-assisted gastrectomy is a feasible and safe surgical procedure with clear operation field, precise dissection, minimal trauma, and fast recovery. Longer follow-up time and randomized, clinical trials are needed to evaluate the clinical benefits and long-term oncological outcomes of this new technology.