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

  • Zheng Bobo
  • Wang Xin
  • Li Jiang
  • Wang Quan
  • Bi Liang
  • Deng Xiangbing
  • Wang ZiqiangEmail author
Review Article



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.


Robotic 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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Zheng Bobo
    • 1
  • Wang Xin
    • 2
  • Li Jiang
    • 3
  • Wang Quan
    • 4
  • Bi Liang
    • 1
  • Deng Xiangbing
    • 1
  • Wang Ziqiang
    • 1
    Email author
  1. 1.Department of Gastrointestinal Surgery, West China HospitalSichuan UniversityChengduChina
  2. 2.Department of GastroenterologyFirst Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  3. 3.Cancer HospitalNational Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical CollegeBeijingChina
  4. 4.Digestive Disease Hospital, Xijing HospitalThe Fourth Military Medical UniversityXi’anChina

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