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A Propensity Score-Matched Comparison of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: Oncological, Cost, and Surgical Stress Analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Robotic-assisted gastrectomy (RAG) has been rapidly adopted for gastric cancer (GC) treatment. However, whether RAG provides any significant outcome/cost advantages over laparoscopy-assisted gastrectomy (LAG) for the experienced laparoscopist remains unclear.

Methods

A retrospective review of a prospectively collected database identified 768 consecutive patients who underwent either RAG (n = 103) or LAG (n = 667) for GC between July 2016 and June 2017 at a large center. A 1:3 matched propensity score analysis was performed. The short-term outcomes and hospital costs between the two groups were compared.

Results

A well-balanced cohort of 404 patients was analyzed (RAG:LAG = 1:3 match). The mean operation times were 226.6 ± 36.2 min for the RAG group and 181.8 ± 49.8 min for the LAG group (p < 0.001). The total numbers of retrieved lymph nodes were similar in the RAG and LAG groups (means 38 and 40, respectively, p = 0.115). The overall and major complication rates (RAG, 13.9% vs. LAG, 12.5%, p = 0.732 and RAG, 3.0% vs. LAG, 1.3%, p = 0.373, respectively) were similar. RAG was much more costly than LAG (1.3 times, p < 0.001) mainly due to the amortization and consumables of the robotic system. According to cumulative sum (CUSUM), the learning phases were divided as follows: phase 1 (cases 1–21), phase 2 (cases 22–63), and phase 3 (cases 64–101), in the robotic group. The surgical stress (SS) was higher in the robotic group compared with the laparoscopic group in phase 1 (p < 0.05). However, the SS did not differ significantly between the two groups in phase 3.

Conclusions

RAG is a feasible and safe surgical procedure for GC, especially in the post-learning curve period. However, further studies are warranted to evaluate the long-term oncological outcomes and to elucidate whether RAG is cost-effective when compared to LAG.

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Funding

This work was supported by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province (2016Y9031), the Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171), the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013), the Youth Scientific Research Subject of Fujian Provincial Health and Family Planning Commission (No. 2015-1-37), and QIHANG Funds of Fujian Medical University (No.2016QH025).

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Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Jun Lu, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Chang-Ming Huang & Chao-Hui Zheng

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Jun Lu, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Chang-Ming Huang & Chao-Hui Zheng

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Jun Lu, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Chang-Ming Huang & Chao-Hui Zheng

  4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Jun Lu, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Chang-Ming Huang & Chao-Hui Zheng

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  1. Jun Lu
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Contributions

JL, CMH, and CHZ conceived and designed the study. HLZ, PL, JWX, JBW, and JXL performed the study. JL and HLZ analyzed the data. QYC, LLC, ML, RHT, and ZNH contributed the reagents/materials/analysis tools. JL wrote the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chang-Ming Huang or Chao-Hui Zheng.

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The authors declare that they have no conflicts of interest.

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Lu, J., Zheng, HL., Li, P. et al. A Propensity Score-Matched Comparison of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: Oncological, Cost, and Surgical Stress Analysis. J Gastrointest Surg 22, 1152–1162 (2018). https://doi.org/10.1007/s11605-018-3785-y

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