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Clinical efficacy and safety of robotic distal gastrectomy for gastric cancer: a systematic review and meta-analysis

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Abstract

Background

Robotic distal gastrectomy (RDG) is a new technique that is rapidly gaining popularity and may help overcome the limitations of laparoscopic distal gastrectomy (LDG); however, its safety and therapeutic efficacy remain controversial. Therefore, this meta-analysis was performed to evaluate the safety and efficacy of RDG.

Methods

We searched PubMed, EMBASE, the Cochrane Library, and Web of Science for studies that compared RDG and LDG and were published between the time of database inception and May 2021. We assessed the bias risk of the observational studies using ROBIN-I, and a random effect model was always applied.

Results

The meta-analysis included 22 studies involving 5386 patients. Compared with LDG, RDG was associated with longer operating time (Mean Difference [MD] = 43.88, 95% CI = 35.17–52.60), less intraoperative blood loss (MD = − 24.84, 95% CI = − 41.26 to − 8.43), a higher number of retrieved lymph nodes (MD = 2.41, 95% CI = 0.77–4.05), shorter time to first flatus (MD = − 0.09, 95% CI = − 0.15 to − 0.03), shorter postoperative hospital stay (MD = − 0.68, 95% CI = − 1.27 to − 0.08), and lower incidence of pancreatic fistula (OR = 0.23, 95% CI = 0.07–0.79). Mean proximal and distal resection margin distances, time to start liquid and soft diets, and other complications were not significantly different between RDG and LDG groups. However, in the propensity-score-matched meta-analysis, the differences in time to first flatus and postoperative hospital stay between the two groups lost significance.

Conclusions

Based on the available evidence, RDG appears feasible and safe, shows better surgical and oncological outcomes than LDG and, comparable postoperative recovery and postoperative complication outcomes.

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Abbreviations

GC:

Gastric cancer

LG:

Laparoscopic gastrectomy

RG:

Robotic gastrectomy

LDG:

Laparoscopic distal gastrectomy

RDG:

Robotic distal gastrectomy

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-Analysis

AMSTAR:

Assessing the methodological quality of systematic reviews

RCTs:

Randomized controlled trials

BMI:

Body mass index

OS:

Overall survival

ORs:

Odds ratios

MD:

Mean difference

95% CrIs:

95% Credible intervals

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Acknowledgements

Thanks for the guidance from the Evidence-Based Medicine Center of Lanzhou University.

Funding

This study was supported by the Key Laboratory of Evidence-Based Medicine and Knowledge Translation Foundation of Gansu Province (Grant No. GSEBMKT-2021KFJJ001). Gansu Provincial Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Tumors (Grant No. 2019GSZDSYS06). NHC key laboratory of Diagnosis and Therapy of Gastrointestinal Tumor (Grant No. 2019PT320005).

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Author notes

  1. Shiyi Gong, Xiong Li, and Hongwei Tian equally contributed to this work and should be acknowledged with first authorship.

Authors and Affiliations

  1. Ningxia Medical University, Yinchuan, 750000, Ningxia, China

    Shiyi Gong, Xiong Li, Kaixuan Zhao & Tiankang Guo

  2. Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China

    Shiyi Gong, Xiong Li, Hongwei Tian, Shaoming Song, Tingting Lu, Wutang Jing, Xianbin Huang, Yongcheng Xu, Xingqiang Wang, Kaixuan Zhao & Tiankang Guo

  3. Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China

    Hongwei Tian, Xianbin Huang & Tiankang Guo

  4. Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China

    Shiyi Gong, Xiong Li, Shaoming Song, Tingting Lu & Kehu Yang

  5. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 222 West Donggang R.D., Lanzhou, 730000, Gansu, China

    Shiyi Gong, Xiong Li, Shaoming Song, Tingting Lu & Kehu Yang

  6. Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, China

    Tingting Lu & Kehu Yang

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  1. Shiyi Gong
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Contributions

Tiankang Guo, and Kehu Yang were involved in the conception and design; Shiyi Gong, Xiong Li, Hongwei Tian, Shaoming Song, Tingting Lu, Wutang Jing, Xianbin Huang, Yongcheng Xu, Xingqiang, Wang, Kaixuan Zhao were involved in the analysis and interpretation of data; Shiyi Gong, Xiong Li, Hongwei Tian were involved in the drafting of the paper or revising; Tiankang Guo, and Kehu Yang were involved the Information Classification: General final approval of the version to be published; and that all authors agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Kehu Yang or Tiankang Guo.

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Shiyi Gong, Xiong Li, Hongwei Tian, Shaoming Song, Tingting Lu, Wutang Jing, Xianbin Huang, Yongcheng Xu, Xingqiang Wang, Kaixuan Zhao, Kehu Yang and Tiankang Guo have no conflict of interest or financial ties to disclose.

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Gong, S., Li, X., Tian, H. et al. Clinical efficacy and safety of robotic distal gastrectomy for gastric cancer: a systematic review and meta-analysis. Surg Endosc 36, 2734–2748 (2022). https://doi.org/10.1007/s00464-021-08994-x

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