Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies
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).
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).
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.
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.
KeywordsRobotic Laparoscopic Gastrectomy Gastric cancer
Compliance with ethical standards
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.
- 1.Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148Google Scholar
- 15.Hyung WJ (2007) Robotic surgery in gastrointestinal surgery. Korean J Gastroenterol 50:256–259Google Scholar
- 17.Buchs NC, Bucher P, Pugin F, Morel P (2011) Robot-assisted gastrectomy for cancer. Minerva Gastroenterol Dietol 57:33–42Google 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
- 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 38:287–298CrossRefGoogle 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
- 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 4:325–327Google 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) 7:443–446Google 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 29:3251–3260CrossRefGoogle 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 263:103–109CrossRefGoogle 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 23:2376–2384CrossRefGoogle Scholar
- 48.NCCN. Clinical Practice Guidelines in Oncology: Gastric Cancer. http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf