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Comparison of Surgical Outcomes of Robot-Assisted and Laparoscopy-Assisted Pylorus-Preserving Gastrectomy for Gastric Cancer: A Propensity Score Matching Analysis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The three-dimensional view and articulating devices in robot system might have a benefit performing the delicate procedure of pylorus-preserving gastrectomy. This study was conducted to evaluate the feasibility and safety of robot-assisted pylorus-preserving gastrectomy (RAPPG) and to compare the perioperative outcomes and oncologic safety between RAPPG and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) for middle-third early gastric cancer.

Methods

Between June 2008 and December 2013, we retrospectively collected data of 68 patients with RAPPG and propensity score matched 68 patients with LAPPG for the treatment of early gastric cancer at Seoul National University Hospital. The covariates for propensity score matching were: age, sex, American Society of Anesthesiologists score, body mass index, and operators. Clinicopathologic characteristics and surgical outcomes were compared between the two groups.

Results

All RAPPG cases were performed successfully without open or laparoscopic conversion. Patient demographics and perioperative outcomes did not differ between the two groups except in operation time (258.3 vs. 193.9 min; P < 0.001). There was no significant difference in complication rates between the two groups (19.1 vs. 22.1 %; P = 0.671). The mean number of examined lymph nodes (33.4 vs. 36.5; P = 0.153), and the mean number of lymph nodes at each station was not different between the two groups.

Conclusions

RAPPG can be a safe treatment option for middle-third early gastric cancer in terms of surgical complications and oncologic outcomes. However, RAPPG has no benefit over LAPPG in this study.

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References

  1. Jeong O, Park YK. Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer. 2011; 11:69–77.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.

    Article  Google Scholar 

  3. Tomita R, Fujisaki S, Tanjoh K. Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg. 2003; 27:725–733.

    Article  PubMed  Google Scholar 

  4. Shibata C, Shiiba K, Funayama Y, et al. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg. 2004; 28:857–861.

    Article  PubMed  Google Scholar 

  5. Nunobe S, SasakoM, Saka M, Fukagawa T, Katai H, Sano T. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007; 10:167–172.

    Article  PubMed  Google Scholar 

  6. Park DJ, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008; 32:1029–1036.

    Article  Google Scholar 

  7. Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy. Ann Surg Oncol. 2009; 16:3252–3258.

    Article  PubMed  Google Scholar 

  8. Yoo MW, Park DJ, Ahn HS, et al. Evaluation of the adequacy of lymph node dissection in pylorus-preserving gastrectomy for early gastric cancer using the maruyama index. World J Surg. 2010; 34:291–295.

    Article  PubMed  Google Scholar 

  9. Horiuchi T, Shimomatsuya T, Chiba Y. Laparoscopically assisted pylorus-preserving gastrectomy. Surg Endosc. 2001; 15:325–328.

    Article  CAS  PubMed  Google Scholar 

  10. Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M. Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg. 2006; 203:162–169.

    Article  PubMed  Google Scholar 

  11. Nunobe S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, Yamaguchi T. Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg. 2007; 31:2335–2340.

    Article  PubMed  Google Scholar 

  12. Tanaka N, Katai H, Saka M, Morita S, Fukagawa T. Laparoscopy-assisted pylorus-preserving gastrectomy: a matched case–control study. Surg Endosc. 2011; 25:114–118.

    Article  PubMed  Google Scholar 

  13. Jiang X, Hiki N, Nunobe S, et al. Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg. 2011; 253:928–933.

    Article  PubMed  Google Scholar 

  14. Suh YS, Han DS, Kong SH, et al. Laparoscopy-assisted pylorus-preserving gastrectomy is better than laparoscopy-assisted distal gastrectomy for middle-third early gastric cancer. Ann Surg. 2014; 259:485–493.

    Article  PubMed  Google Scholar 

  15. Anderson C, Ellenhorn J, Hellan M, Pigazzi A. Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc. 2007; 21:1662–1666.

    Article  PubMed  Google Scholar 

  16. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009; 249:927–932.

    Article  PubMed  Google Scholar 

  17. Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc. 2010; 24:610–615.

    Article  PubMed  Google Scholar 

  18. Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, Noh SH. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg. 2011; 146:1086–1092.

    Article  PubMed  Google Scholar 

  19. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual, 7th ed. New York: Springer; 2009.

    Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat. 1985; 39:33–38.

    Google Scholar 

  22. D`Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998; 17:2265–2281.

  23. Yoon HM, Kim YW, Lee JH, et al. Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc. 2012; 26:1377–1381.

    Article  PubMed  Google Scholar 

  24. Park JY, Jo MJ, Nam BH, et al. Surgical stress after robot-assisted distal gastrectomy and its economic implications. Br J Surg. 2012; 99:1554–1561.

    Article  CAS  PubMed  Google Scholar 

  25. Hur H, Kim JY, Cho YK, Han SU. Technical feasibility of robot-sewn anastomosis in robotic surgery for gastric cancer. J Laparoendosc Adv Surg Tech. 2010; 20:693–697.

    Article  Google Scholar 

  26. Stefanidis D, Wang F, Korndorffer J, Dunne JB, Scott DJ. Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc. 2010; 24:377–382.

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported by a research fund from the Seoul National University School of Medicine, Seoul, Korea (Grant No. 800-20130198). Statistical analysis was supported by the Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.

Disclosure

The authors declare no conflicts of interest.

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Author notes

  1. Dong-Seok Han MD

    Present address: Department of Surgery, Konkuk University School of Medicine, Seoul, Korea

Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Dong-Seok Han MD, Yun-Suhk Suh MD, Seong-Ho Kong MD, PhD, Hyuk-Joon Lee MD, PhD & Han-Kwang Yang MD, PhD

  2. Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea

    Hye Seong Ahn MD, PhD

  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Hyuk-Joon Lee MD, PhD, Woo-Ho Kim MD, PhD & Han-Kwang Yang MD, PhD

  4. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    Woo-Ho Kim MD, PhD

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  1. Dong-Seok Han MD
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  2. Yun-Suhk Suh MD
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  3. Hye Seong Ahn MD, PhD
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  4. Seong-Ho Kong MD, PhD
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Corresponding author

Correspondence to Han-Kwang Yang MD, PhD.

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Han, DS., Suh, YS., Ahn, H.S. et al. Comparison of Surgical Outcomes of Robot-Assisted and Laparoscopy-Assisted Pylorus-Preserving Gastrectomy for Gastric Cancer: A Propensity Score Matching Analysis. Ann Surg Oncol 22, 2323–2328 (2015). https://doi.org/10.1245/s10434-014-4204-6

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  • DOI: https://doi.org/10.1245/s10434-014-4204-6

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