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Advantages of a robotic approach compared with laparoscopy gastrectomy for patients with high visceral fat area

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Abstract

Background

Gastric cancer surgery for obese patients is regarded as a technically challenging procedure. The morbidity after gastrectomy has been reported to be significantly higher in patients with high visceral fat area (VFA). Robotic gastrectomy (RG) is expected to be advantageous for complicated operations. However, whether RG is superior to conventional laparoscopic gastrectomy (LG) for patients with visceral fat obesity remains unclear. The present study aimed to clarify the impact of RG on the short- and long-term outcomes of patients with high VFAs.

Methods

This study included 1306 patients with clinical stage I/II gastric cancer who underwent minimally invasive gastrectomy between January 2012 and December 2020. The patients were subclassified according to VFA. The short- and long-term outcomes of RG were compared with those of LG in two VFA categories.

Results

This study included 394 (high-VFA, 151; low-VFA, 243) and 882 patients (high-VFA, 366; low-VFA, 516) in the RG and LG groups, respectively. RG was associated with a significantly longer operative time than LG (high-VFA, P < 0.001; low-VFA, P < 0.001). The incidence rates of overall and intra-abdominal infectious complications in the high-VFA patients were lower in the RG group than in the LG group (P = 0.019 and P = 0.048, respectively) but not significantly different from those in the low-VFA patients. In the multivariate analysis, LG was identified as the only independent risk factor of overall (odds ratio [OR] 3.281; P = 0.012) and intra-abdominal infectious complications (OR 3.462; P = 0.021) in the high-VFA patients. The overall survival of high-VFA patients was significantly better in the RG group than in the LG group (P = 0.045).

Conclusions

For patients with visceral fat obesity, RG appears to be advantageous to LG in terms of reducing the risk of complications and better long-term survival.

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Acknowledgements

We thank R. Makuuchi, T. Irino, and M. Tokunaga for data acquisition.

Funding

This study was not supported by any specific grants from any funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Makoto Hikage, Keiichi Fujiya, Yuhei Waki, Satoshi Kamiya, Yutaka Tanizawa, Etsuro Bando & Masanori Terashima

  2. Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan

    Akifumi Notsu

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  1. Makoto Hikage
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  2. Keiichi Fujiya
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  3. Yuhei Waki
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  4. Satoshi Kamiya
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  5. Yutaka Tanizawa
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  6. Etsuro Bando
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  7. Akifumi Notsu
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Correspondence to Masanori Terashima.

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Disclosures

Dr. Masanori Terashima received personal fees from Taiho, Chugai, Ono, Bristol-Myers Squibb, Yakult, Takeda, Eli Lilly, Pfizer, and Daiichi Sankyo, outside the submitted work. Drs. Makoto Hikage, Keiichi Fujiya, Yuhei Waki, Satoshi Kamiya, Yutaka Tanizawa, Etsuro Bando, and Akifumi Notsu have no conflicts of interest or financial ties to disclose.

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Hikage, M., Fujiya, K., Waki, Y. et al. Advantages of a robotic approach compared with laparoscopy gastrectomy for patients with high visceral fat area. Surg Endosc 36, 6181–6193 (2022). https://doi.org/10.1007/s00464-022-09178-x

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