Skip to main content

Advertisement

SpringerLink
Log in

Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Purpose

Despite theoretical advantages, no clear benefit was proven for initial application of robotic surgery for gastric cancer so far. The aim of this analysis was to examine the role of robotic surgery regarding nodal dissection technically demanding areas compared to conventional laparoscopic surgery.

Methods

This analysis included 87 patients who underwent robot-assisted distal gastrectomy (RADG) and 288 patients who underwent laparoscopy-assisted distal gastrectomy (LADG) at the National Cancer Center, Korea, between February 2009 and September 2011. Clinicopathologic data, surgery-related data, postoperative morbidity, and pathologic data for each nodal station were analyzed.

Results

Time to flatulence was 3.5 ± 0.8 days for RADG and 3.8 ± 0.8 days for LADG (P = 0.01). Postoperative hospital stay was 6.7 ± 1.0 days in RADG and 7.4 ± 2.4 days in LADG (P < 0.001).The number of dissected lymph nodes was 37.1 ± 12.9 in the RADG group and 34.1 ± 12.1 in the LADG group (P = 0.044). In patients undergoing D2 gastrectomy, the number of dissected lymph nodes in the N2 area was 16.3 ± 7.7 for RADG and 13.2 ± 5.3 for LADG (P = 0.001). The number of dissected lymph nodes around the splenic artery area was 2.9 ± 2.9 in RADG and 2.2 ± 2.0 in LADG (P = 0.04). Regarding postoperative complications, there was no statistically significant difference [five patients (5.7 %) in RADG and 26 patients (9 %) in LADG) (P = 0.330)].

Conclusion

RADG could provide an advantage over LADG in the dissection of the N2 area lymph nodes, especially around the splenic artery area.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Park JY, Jo MJ, Nam BH, Kim Y, Eom BW, Yoon HM, Ryu KW, Kim YW, Lee JH (2012) Surgical stress after robot-assisted distal gastrectomy and its economic implications. Br J Surg 99:1554–1561

    Article  CAS  PubMed  Google Scholar 

  2. 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 100:1566–1578

    Article  CAS  PubMed  Google Scholar 

  3. Meakins JL (2002) Innovation in surgery: the rules of evidence. Am J Surg 183:399–405

    Article  PubMed  Google Scholar 

  4. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727

    Article  PubMed  Google Scholar 

  5. Kim YW, Yoon HM, Yun YH, Nam BH, Eom BW, Baik YH, Lee SE, Lee Y, Kim YA, Park JY, Ryu KW (2013) Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc 27:4267–4276

    Article  PubMed  Google Scholar 

  6. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case–control and case-matched Korean multicenter study. J Clin Oncol 32(7):627–633

    Article  PubMed  Google Scholar 

  7. Yasunaga H, Horiguchi H, Kuwabara K, Matsuda S, Fushimi K, Hashimoto H, Ayanian J (2013) Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer: a propensity-matched analysis. Ann Surg 257:640–646

    Article  PubMed  Google Scholar 

  8. Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52.

    Article  PubMed  Google Scholar 

  9. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72

    Article  PubMed  PubMed Central  Google Scholar 

  10. Strong V, Devaud N, Allen P, Gonen M, Brennan M, Coit D (2009) Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case–control study. Ann Surg Oncol 16:1507–1513

    Article  PubMed  Google Scholar 

  11. Kim MC, Heo GU, Jung GJ (2010) Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 24:610–615

    Article  PubMed  Google Scholar 

  12. Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, Noh SH (2011) Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg 146(9):1086–1092

    Article  PubMed  Google Scholar 

  13. Eom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY, Kim CG, Choi IJ, Lee JS, Kook MC, Rhee JY, Park SR, Kim YW (2012) Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol (EJSO) 38:57–63

    Article  CAS  Google Scholar 

  14. Yoon H, Kim Y-W, Lee J, Ryu K, Eom B, Park J, Choi I, Kim C, Lee J, Cho S, Rho J (2011) Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc 26(5):1377–1381

    Article  PubMed  Google Scholar 

  15. Bickenbach K, Strong VE (2012) Comparisons of gastric cancer treatments: east versus West. J Gastric Cancer 12:55–62

    Article  PubMed  PubMed Central  Google Scholar 

  16. Coratti A, Annecchiarico M, Di Marino M, Gentile E, Coratti F, Giulianotti P (2013) Robot-assisted gastrectomy for gastric cancer: current status and technical considerations. World J Surg 37:2771–2781

    Article  PubMed  Google Scholar 

  17. Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH (2009) Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc 23:1204–1211

    Article  PubMed  Google Scholar 

  18. 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): 1180–1187

    Article  PubMed  Google Scholar 

  19. Park SS, Kim MC, Park MS, Hyung WJ (2012) Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc 26:60–67

    Article  PubMed  Google Scholar 

  20. Park JY, Kim YW, Ryu KW, Eom BW, Yoon HM, Reim D (2013) Emerging role of robot-assisted gastrectomy: analysis of consecutive 200 cases. J Gastric Cancer 13:255–262

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK (2012) Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc 26:3418–3425

    Article  PubMed  Google Scholar 

  22. Kim MG, Kim HS, Kim BS, Kwon SJ (2013) The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc 27:3990–3997

    Article  PubMed  Google Scholar 

  23. 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 19:8696–8702

    Article  PubMed  PubMed Central  Google Scholar 

  24. Otsuji E, Fujiyama J, Takagi T, Ito T, Kuriu Y, Toma A, Okamoto K, Hagiwara A, Yamagishi H (2005) Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients. J Surg Oncol 91:232–236

    Article  PubMed  Google Scholar 

  25. Seo SH, Hur H, An CW, Yi X, Kim JY, Han SU, Cho YK (2011) Operative risk factors in gastric cancer surgery for elderly patients. J Gastric Cancer 11:116–121

    Article  PubMed  PubMed Central  Google Scholar 

  26. Pugliese R, Maggioni D, Sansonna F, Costanzi A, Ferrari G, Di Lernia S, Magistro C, Martini P, Pugliese F (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602

    Article  PubMed  Google Scholar 

  27. D’Annibale A, Pende V, Pernazza G, Monsellato I, Mazzocchi P, Lucandri G, Morpurgo E, Contardo T, Sovernigo G (2011) Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results. J Surg Res 166:e113–e120

    Article  PubMed  Google Scholar 

  28. Marano A, Choi YY, Hyung WJ, Kim YM, Kim J, Noh SH (2013) Robotic versus laparoscopic versus open gastrectomy: a meta-analysis. J Gastric Cancer 13:136–148

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yu H, Friedlander DF, Patel S, Hu JC (2013) The current status of robotic oncologic surgery. CA Cancer J Clin 63:45–56

    Article  PubMed  Google Scholar 

  30. 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):1779–1787

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea

    Young-Woo Kim, Daniel Reim, Ji Yeon Park, Bang Wool Eom, Myeong-Cherl Kook, Keun Won Ryu & Hong Man Yoon

Authors
  1. Young-Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Reim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji Yeon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bang Wool Eom
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Myeong-Cherl Kook
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keun Won Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hong Man Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong Man Yoon.

Ethics declarations

Disclosures

Young-Woo Kim, Hong Man Yoon, Ji Yeon Park, Daniel Reim, Bang-Ul Eom, Myeong-Cherl Kook, and Keun Won Ryu have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, YW., Reim, D., Park, J.Y. et al. Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc 30, 1547–1552 (2016). https://doi.org/10.1007/s00464-015-4372-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4372-x

Keywords

Search

Navigation