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Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies

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Abstract

Background

To evaluate short- and long-term outcomes of robotic gastrectomy (RG) in patients with gastric cancer to determine whether RG is an acceptable alternative to laparoscopic gastrectomy (LG).

Methods

PubMed, Embase, the Cochrane Library, and Chinese Biomedical Database were searched for prospective observational studies (POSs) comparing RG with LG for gastric cancer until October 2017. We compared short-term and long-term outcomes using systematic review with meta-analysis and trial sequential analysis (TSA).

Results

Sixteen POSs including 4576 patients were included in the meta-analyses. Compared with LG, RG had longer operative time (MD 57.98 min, P < 0.00001), lesser blood loss (MD − 23.71 ml, P = 0.005), and shorter time to first post-operative flatulence (MD − 0.14 days, P = 0.03). No significant difference was found in terms of the number of harvested lymph nodes, complications, reoperation, mortality, open conversion, proximal resection margin, and distal resection margin. The meta-analyses of complications, overall survival, and disease-free survival did not yield any sign of statistically significant difference between the two treatments, and the cumulative Z-curve crossed neither the traditional boundary nor the trial sequential monitoring boundary, suggesting the lack of firm evidence. TSA demonstrated that the cumulative Z-curve crossed either the traditional boundary or the trial sequential monitoring boundary on blood loss and operative time.

Conclusions

The present study demonstrates that RG is as acceptable as LG in terms of short- and long-term outcomes. The TSA demonstrated that further studies are not needed to evaluate the operative time and blood loss differences between these techniques.

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References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    CAS  PubMed  Google Scholar 

  2. Qiu J, Pankaj P, Jiang H, Zeng Y, Wu H (2013) Laparoscopy versus open distal gastrectomy for advanced gastric cancer: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 23:1–7

    Article  PubMed  Google Scholar 

  3. Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52

    Article  PubMed  Google Scholar 

  4. Ding J, Liao GQ, Liu HL, Liu S, Tang J (2012) Meta-analysis of laparoscopy-assisted distal nastrectomy with D2 lymph node dissection for gastric cancer. J Surg Oncol 105:297–303

    Article  PubMed  Google Scholar 

  5. Yakoub D, Athanasiou T, Tekkis P, Hanna GB (2009) Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach? Surg Oncol 18:322–333

    Article  PubMed  Google Scholar 

  6. Lee JH, Han HS (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173

    Article  PubMed  Google Scholar 

  7. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420

    Article  PubMed  Google Scholar 

  8. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487

    Article  PubMed  Google Scholar 

  9. Kim MC, Jung GJ, Kim HH (2005) Learning curve of laparoscopy assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 11:7508–7511

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jin SH, Kim DY, Kim H, Jeong IH, Kim MW (2007) Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 21:28–33

    Article  PubMed  Google Scholar 

  11. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14–21

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P (2004) Robot-assisted abdominal surgery. Br J Surg 91:1390–1397

    Article  CAS  PubMed  Google Scholar 

  13. Hashizume M, Sugimachi K (2003) Robot-assisted gastric surgery. Surg Clin North Am 83:1429–1444

    Article  PubMed  Google Scholar 

  14. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784

    Article  PubMed  Google Scholar 

  15. Hyung WJ (2007) Robotic surgery in gastrointestinal surgery. Korean J Gastroenterol 50:256–259

    PubMed  Google Scholar 

  16. Baek SJ, Lee DW, Park SS, Kim SH (2011) Current status of robot-assisted gastric surgery. World J Gastrointest Oncol 3:137–143

    Article  PubMed  PubMed Central  Google Scholar 

  17. Buchs NC, Bucher P, Pugin F, Morel P (2011) Robot-assisted gastrectomy for cancer. Minerva Gastroenterol Dietol 57:33–42

    CAS  PubMed  Google Scholar 

  18. Pan JH, Zhou H, Zhao XX, Ding H, Qin L, Pan YL(2017) Long-term oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-017-5891-4

    Article  PubMed  Google Scholar 

  19. Chen K, Pan Y, Zhang B, Maher H, Wang XF, Cai XJ (2017) Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg 24(1):93

    Article  Google Scholar 

  20. Shen WS, Xi HQ, Chen L, Wei B (2014) A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc 28:2795–2802

    Article  PubMed  Google Scholar 

  21. Borm GF, Donders AR (2009) Updating meta-analyses leads to larger type I errors than publication bias. J Clin Epidemiol 62:825–830

    Article  PubMed  Google Scholar 

  22. Wetterslev J, Thorlund K, Brok J, Gluud C. Trial (2008) sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 61:64–75

    Article  PubMed  Google Scholar 

  23. Thorlund K, Devereaux PJ, Wetterslev J, Guyatt G, Ioannidis JP, Thabane L, Gluud LL, Als-Nielsen B, Gluud C (2009) Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses? Int J Epidemiol 38:276–286

    Article  PubMed  Google Scholar 

  24. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ott. Hosp. Res. Inst. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  25. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926

    Article  PubMed  PubMed Central  Google Scholar 

  26. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834

    Article  CAS  PubMed  Google Scholar 

  27. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8:16

    Article  PubMed  PubMed Central  Google Scholar 

  28. Brok J, Thorlund K, Gluud C, Wetterslev J (2008) Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. J Clin Epidemiol 61:763–769

    Article  PubMed  Google Scholar 

  29. Brok J, Thorlund K, Wetterslev J, Gluud C (2009) Apparently conclusive meta-analyses may be inconclusive - Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. Int J Epidemiol 38:287–298

    Article  PubMed  Google Scholar 

  30. Thorlund K, Engstrøm J, Wetterslev J, Brok J, Imberger G, Gluud C (2011) User Manual for Trial Sequential Analysis (TSA), Copenhagen Trial Unit, Centre for Clinical Intervention Research. http://www.ctu.dk/tsa

  31. Pugliese R, Maggioni D, Sansonna F, Costanzi A, Ferrari GC (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  33. Kim KM, An JY, Kim HI, Cheong JH, Hyung WJ, Noh SH (2012) Major early complications following open, laparoscopic and robotic gastrectomy. Br J Surg 99:1681–1687

    Article  CAS  PubMed  Google Scholar 

  34. Son SY, Lee CM, Ahn SH, Lee JH, Park DJ, Kim HH (2012) Clinical outcome of robotic Gastrectomy in gastric cancer in comparison with laparoscopic Gastrectomy: a case-control study. J Min Invas Surg 15:27–31

    Article  Google Scholar 

  35. Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han SU (2012) Comparison of surgical outcomes between robotic and laparoscopic Gastrectomy for gastric cancer:the learning curve of robotic surgery. J Gastric Cancer 12:156–163

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hyun MH1, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH, Kim JH, Park SH, Mok YJ, Park SS (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20:1258–1265

    Article  PubMed  Google Scholar 

  37. Zhao Kun P, Huafeng W, Gang-Li M, Hu W, Jiang Zhiwei (2013) Contrast study of short-term effect between the Da Vinci surgical robot and laparoscopic technology in patients after distal gastric cancer surgery. Chin J Pract Surg 4:325–327

    Google Scholar 

  38. Xue Yonggan Z, Bingdong L, Peng L, Hongyi, Jia Baoqin (2014) Evaluation of clinical short-term outcomes of da Vinci robotic gastrectomy. Chin J Laparosc Surg (Electronic Edition) 7:443–446

    Google Scholar 

  39. Son T, Lee JH, Kim YM, Kim HI, Noh SH, Hyung WJ (2014) Robotic spleenpreserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 28:2606–2615

    Article  PubMed  Google Scholar 

  40. Noshiro H, Ikeda O, Urata M (2014) Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone. Surg Endosc 28:1180–1187

    Article  PubMed  Google Scholar 

  41. Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Li AF, Chiou SH, Wu CW, Shyr YM (2014) Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS ONE 9:e111499

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Park JY1, Ryu KW, Reim D, Eom BW, Yoon HM, Rho JY, Choi IJ, Kim YW (2015) Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy? World J Surg 39:1789–1797

    Article  PubMed  Google Scholar 

  43. Lee J, Kim YM, Woo Y, Obama K, Noh SH, Hyung WJ (2015) Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc 29:3251–3260

    Article  PubMed  Google Scholar 

  44. Kim HI1, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, Park JM, An JY, Kim MC, Park S, Song KY, Oh SJ, Kong SH, Suh BJ, Yang DH, Ha TK, Kim YN, Hyung WJ (2016) Multicenter prospective comparative study of robotic versus laparoscopic Gastrectomy for gastric Adenocarcinoma. Ann Surg 263:103–109

    Article  PubMed  Google Scholar 

  45. Okumura N, Son T, Kim YM, Kim HI, An JY, Noh SH, Hyung WJ (2016) Robotic gastrectomy for elderly gastric cancer patients: comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly. Gastric Cancer 19:1125–1134

    Article  PubMed  Google Scholar 

  46. Parisi A, Reim D, Borghi F, Nguyen NT, Qi F, Coratti A, Cianchi F, Cesari M, Bazzocchi F, Alimoglu O, Gagnière J, Pernazza G, D’Imporzano S, Zhou YB, Azagra JS, Facy O, Brower ST, Jiang ZW, Zang L, Isik A, Gemini A, Trastulli S, Novotny A, Marano A, Liu T, Annecchiarico M, Badii B, Arcuri G, Avanzolini A, Leblebici M, Pezet D, Cao SG, Goergen M, Zhang S, Palazzini G, D’Andrea V, Desiderio J (2017) Minimally invasive surgery for gastric cancer: a comparison between robotic, laparoscopic and open surgery. World J Gastroenterol 23:2376–2384

    Article  PubMed  PubMed Central  Google Scholar 

  47. Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH (2009) Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc 23:1204–1211

    Article  PubMed  Google Scholar 

  48. NCCN. Clinical Practice Guidelines in Oncology: Gastric Cancer. http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf

  49. Japanese gastric cancer treatment (2011) guidelines 2010 (ver. 3). Gastric cancer 14:113–123 DOI: 10.1007/s10120-011-0042-4

    Article  Google Scholar 

  50. Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg 238:680–685

    Article  PubMed  PubMed Central  Google Scholar 

  51. Yasuda K, Inomata M, Shiraishi N, Izumi K, Ishikawa K (2004) Laparoscopy-assisted distal gastrectomy for early gastric cancer in obese and nonobese patients. Surg Endosc 18:1253–1256

    Article  CAS  PubMed  Google Scholar 

  52. Obama K, Kim YM, Kang DR, Son T, Kim HI, Noh SH, Hyung WJ (2017) Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer. https://doi.org/10.1007/s10120-017-0740-7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China

    Zheng Bobo, Bi Liang, Deng Xiangbing & Wang Ziqiang

  2. Department of Gastroenterology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, Shaanxi, China

    Wang Xin

  3. Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100021, China

    Li Jiang

  4. Digestive Disease Hospital, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032, Shaanxi, China

    Wang Quan

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  1. Zheng Bobo
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Correspondence to Wang Ziqiang.

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Zheng Bobo, Wang Xin, Li Jiang, Wang Quan, Bi Liang, Deng Xiangbing and Wang Ziqiang have no conflicts of interest or financial ties to disclose.

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Bobo, Z., Xin, W., Jiang, L. et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies. Surg Endosc 33, 1033–1048 (2019). https://doi.org/10.1007/s00464-018-06648-z

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