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Short- and long-term comparison of robotic and laparoscopic gastrectomy for gastric cancer by the same surgical team: a propensity score matching analysis

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Abstract

Background

Research on short-term outcomes and oncology results after robotic gastrectomy (RG) is still limited, especially from a single surgical team. The purpose of this study was to compare the short-term and long-term outcomes of robotic and laparoscopic gastrectomy (LG).

Methods

Between October 2014 and September 2019, 1686 consecutive patients who underwent MIS gastrectomy were enrolled. The patients were divided into RG and LG groups according to surgical type. Groups were matched at a 1:1 ratio using propensity scores based on the following variables: age, sex, ASA score, primary tumor location, histologic type, pathological stage, and neoadjuvant chemotherapy. The primary outcomes were 3-year overall survival (OS) and relapse-free survival (RFS). The secondary outcomes were postoperative short-term outcomes.

Results

Demographic and baseline characteristics were similar between the two groups after matching. Compared to the LG group, the RG group had a significantly higher retrieved lymph node (LN) number (32.15 vs 30.82, P = 0.040), more retrieved supra-pancreatic LNs (12.45 vs 11.61, P = 0.028), lower estimated blood loss (73.67 vs 98.08 ml, P < 0.001), but longer operation time (205.18 vs 185.27 min, P < 0.001) and higher hospitalization costs ($13,607 vs $10,928, P < 0.001) in the matched cohort. In the subgroup analysis, we observed that compared with LG, patients with advanced gastric cancer benefitted more from RG surgery. The matched cohort analysis demonstrated no statistically significant differences for 3-year OS or RFS (log-rank, P = 0.648 and P = 0.951, respectively): 80.3% and 77.0% in LG vs. 81.2% and 76.6% in RG, respectively.

Conclusion

RG has certain technical advantages over LG, especially in patients with advanced gastric cancer. However, RG does not improve long-term oncology outcomes.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China

    Yulong Tian, Shougen Cao, Ying Kong, Shuai Shen, Zhaojian Niu, Jian Zhang, Dong Chen, Haitao Jiang, Liang Lv, Xiaodong Liu, Zequn Li, Hao Zhong & Yanbing Zhou

  2. Department of Gastrointestinal Surgery, Jining No. 1 People’s Hospital, No. 6 Jiankang Road, Central District, Jining City, 272013, Shandong Province, China

    Ying Kong

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  1. Yulong Tian
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Correspondence to Yanbing Zhou.

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Disclosures

Yulong Tian, Ying Kong, Shuai Shen, Shougen Cao, Zhaojian Niu, Jian Zhang, Dong Chen, Haitao Jiang, Liang Lv, Xiaodong Liu, Zequn Li, Hao Zhong, and Yanbing Zhou have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by the Affiliated Hospital of Qingdao University ethics review committee (Approval Number QYFYWZLL-25979). All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent or substitute for it was obtained from all patients for being included in the study.

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Tian, Y., Cao, S., Kong, Y. et al. Short- and long-term comparison of robotic and laparoscopic gastrectomy for gastric cancer by the same surgical team: a propensity score matching analysis. Surg Endosc 36, 185–195 (2022). https://doi.org/10.1007/s00464-020-08253-5

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