Advertisement

Surgical Endoscopy

, Volume 29, Issue 3, pp 673–685 | Cite as

Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study

  • Koichi Suda
  • Mariko Man-i
  • Yoshinori Ishida
  • Yuichiro Kawamura
  • Seiji Satoh
  • Ichiro Uyama
Article

Abstract

Background

We have previously reported that laparoscopic approach improved short-term postoperative courses even for advanced gastric adenocarcinoma, but not morbidity, in comparison with open approach. The objective of this study was to determine the impact of the use of the surgical robot, da Vinci Surgical System, in minimally invasive radical gastrectomy on short-term outcomes.

Methods

A single institutional retrospective cohort study was performed (UMIN000011749). Five hundred twenty-six patients who underwent radical gastrectomy were enrolled. Eighty-eight patients who agreed to uninsured use of the surgical robot underwent robotic gastrectomy, whereas the remaining 438 patients who wished for laparoscopic (lap) approach with health insurance coverage underwent conventional laparoscopic gastrectomy.

Results

In the robotic group, morbidity (robotic vs lap 2.3 vs 11.4 %, p = 0.009) and hospital stay following surgery (robotic vs lap 14 [2–31] vs 15 [8–136] days, p = 0.021) were significantly improved, even though operative time (p = 0.003) and estimated blood loss (p = 0.026) were slightly greater. In particular, local (robotic vs lap 1.1 vs 9.8 %, p = 0.007) rather than systemic (robotic vs lap 1.1 vs 2.5 %, p = 0.376) complication rates were attenuated using the surgical robot. Multivariate analyses revealed that non-use of the surgical robot (OR 6.174 [1.454–26.224], p = 0.014), total gastrectomy (OR 4.670 [2.503–8.713], p < 0.001), and D2 lymphadenectomy (OR 2.095 [1.124–3.903], p = 0.020) were the significant independent risk factors determining postoperative complications.

Conclusions

The use of the surgical robot might reduce surgery-related complications, leading to further improvement in short-term postoperative courses following minimally invasive radical gastrectomy.

Keywords

Gastric cancer Robotic gastrectomy Laparoscopic gastrectomy Complication Pancreatic fistula 

Abbreviations

Lap

Laparoscopic

EGC

Early gastric cancer

AGC

Advanced gastric cancer

JCGC

Japanese Classification of Gastric Carcinoma

Ccr

Creatinine clearance

PaO2

Arterial oxygen pressure

JGCA

Japanese Gastric Cancer Association

FEEA

Functional end-to-end anastomosis

R3

Robotic third arm

R1

Robotic first arm

R2

Robotic second arm

OR

Odds ratio

NCCN

National Comprehensive Cancer Network

Notes

Acknowledgments

The authors wish to express special thanks to Professor Masaki Kitajima for his wonderful supervision of this project. The authors are indebted to Ms. Michelle Paknad for her review of this manuscript.

Disclosures

All the authors (K.S., M.M., Y.I., Y.K., S.S., and I.U.) have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Crew KD, Neugut AI (2006) Epidemiology of gastric cancer. World J Gastroenterol 12:354–362PubMedCentralPubMedGoogle Scholar
  2. 2.
    Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy: Japan Clinical Oncology Group study 9501. J Clin Oncol 22:2767–2773PubMedCrossRefGoogle Scholar
  3. 3.
    NCCN Guidelines Version 2.2011 Gastric Cancer. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp
  4. 4.
    Bamboat ZM, Strong VE (2013) Minimally invasive surgery for gastric cancer. J Surg Oncol 107:271–276PubMedCrossRefGoogle Scholar
  5. 5.
    Wei HB, Wei B, Qi CL, Chen TF, Huang Y, Zheng ZH, Huang JL, Fang JF (2011) Laparoscopic versus open gastrectomy with D2 lymph node dissection for gastric cancer: a meta-analysis. Surg Laparosc Endosc Percutan Tech 21:383–390PubMedCrossRefGoogle Scholar
  6. 6.
    Angst E, Hiatt JR, Gloor B, Reber HA, Hines OJ (2010) Laparoscopic surgery for cancer: a systematic review and a way forward. J Am Coll Surg 211:412–423PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294PubMedCrossRefGoogle Scholar
  8. 8.
    Suda K, Ishida Y, Kawamura Y, Inaba K, Kanaya S, Teramukai S, Satoh S, Uyama I (2012) Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg 36:1608–1616PubMedCrossRefGoogle Scholar
  9. 9.
    Boone J, Schipper ME, Moojen WA et al (2009) Robot-assisted thoracoscopic oesophagectomy for cancer. Br J Surg 96:878–886PubMedCrossRefGoogle Scholar
  10. 10.
    Ruurda JP, van Vroonhoven TJ, Broeders IA (2002) Robot-assisted surgical systems: a new era in laparoscopic surgery. Ann R Coll Surg Engl 84:223–226PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Camarillo DB, Krummel TM, Salisbury JK Jr (2004) Robotic technology in surgery: past, present, and future. Am J Surg 188:2S–15SPubMedCrossRefGoogle Scholar
  12. 12.
    Coratti A, Annecchiarico M, Coratti A, Di Marino M, Gentile E, Coratti F, Giulianotti PC (2013) Robot-assisted gastrectomy for gastric cancer: current status and technical considerations. World J Surg 37:2771–2781PubMedCrossRefGoogle Scholar
  13. 13.
    Ministry of Health, Labor and Welfare. Annual health, labor and welfare report 2009–2010. http://www.mhlw.go.jp/english/wp/wp-hw4/02.html
  14. 14.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRefGoogle Scholar
  16. 16.
    Lee JH, Park do J, Kim HH, Lee HJ, Yang HK (2012) Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien-Dindo classification. Surg Endosc 26:1287–1295PubMedCrossRefGoogle Scholar
  17. 17.
    Japan Clinical Oncology Group. Postoperative Complication Criteria according to Clavien-Dindo Classification ver. 2.0. http://www.jcog.jp/doctor/tool/Clavien_Dindo.html
  18. 18.
    Japanese Gastric Cancer Association (2011) Japanese Classification of Gastric Carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  19. 19.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655PubMedCrossRefGoogle Scholar
  20. 20.
    Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S (2012) Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg 36:331–337PubMedCrossRefGoogle Scholar
  21. 21.
    Kanaya S, Haruta S, Kawamura Y, Yoshimura F, Inaba K, Hiramatsu Y, Ishida Y, Taniguchi K, Isogaki J, Uyama I (2011) Video: laparoscopy distinctive technique for suprapancreatic lymph node dissection: medial approach for laparoscopic gastric cancer surgery. Surg Endosc 25:3928–3929PubMedCrossRefGoogle Scholar
  22. 22.
    Uyama I, Suda K, Satoh S (2013) Laparoscopic surgery for advanced gastric cancer: current status and future perspectives. J Gastric Cancer 13:19–25PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  24. 24.
    Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287PubMedCrossRefGoogle Scholar
  25. 25.
    Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234PubMedCrossRefGoogle Scholar
  26. 26.
    Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–e29PubMedCrossRefGoogle Scholar
  27. 27.
    Yu HW, Jung do H, Son SY, Lee CM, Lee JH, Ahn SH, Park do J, Kim HH (2013) Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery. J Gastric Cancer 13:179–184PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Xiong B, Ma L, Zhang C (2012) Robotic versus laparoscopic gastrectomy for gastric cancer: a meta-analysis of short outcomes. Surg Oncol 21:274–280PubMedCrossRefGoogle Scholar
  29. 29.
    Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z, Yongliang Z, Feng Q, Peiwu Y (2014) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc 28(6):1779–1787PubMedCrossRefGoogle Scholar
  30. 30.
    Liao GX, Xie GZ, Li R, Zhao ZH, Sun QQ, Du SS, Ren C, Li GX, Deng HJ, Yuan YW (2013) Meta-analysis of outcomes compared between robotic and laparoscopic gastrectomy for gastric cancer. Asian Pac J Cancer Prev 14:4871–4875PubMedCrossRefGoogle Scholar
  31. 31.
    Hyun MH, Lee CH, Kim HJ, Tong Y, Park SS (2013) Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma. Br J Surg 100:1566–1578PubMedGoogle Scholar
  32. 32.
    Noshiro H, Ikeda O, Urata M (2013) Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone. Surg Endosc 28(4):1180–1187PubMedCrossRefGoogle Scholar
  33. 33.
    Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92:1099–1102PubMedCrossRefGoogle Scholar
  34. 34.
    Persiani R, Antonacci V, Biondi A, Rausei S, La Greca A, Zoccali M, Ciccoritti L, D’Ugo D (2008) Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg 207:13–19PubMedCrossRefGoogle Scholar
  35. 35.
    Komatsu S, Ichikawa D, Kashimoto K, Kubota T, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2013) Risk factors to predict severe postoperative pancreatic fistula following gastrectomy for gastric cancer. World J Gastroenterol 19:8696–8702PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Kenngott HG, Fischer L, Nickel F, Rom J, Rassweiler J, Müller-Stich BP (2012) Status of robotic assistance: a less traumatic and more accurate minimally invasive surgery? Langenbecks Arch Surg 397:333–341PubMedCrossRefGoogle Scholar
  37. 37.
    Park SS, Kim MC, Park MS, Hyung WJ (2012) Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc 26:60–67PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Koichi Suda
    • 1
  • Mariko Man-i
    • 1
  • Yoshinori Ishida
    • 1
  • Yuichiro Kawamura
    • 1
  • Seiji Satoh
    • 1
  • Ichiro Uyama
    • 1
  1. 1.Division of Upper GI, Department of SurgeryFujita Health UniversityToyoakeJapan

Personalised recommendations