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Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer

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Abstract

Background

Robot-assisted distal gastrectomy (RADG) has been used in the minimally invasive surgical treatment of gastric cancer, but the research on advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NAC) has not been reported. This study aimed to analyze the outcomes of RADG versus laparoscopic distal gastrectomy (LDG) after NAC for AGC.

Methods

This was a retrospective propensity score-matched analysis from February 2020 and March 2022. Patients who underwent RADG or LDG for AGC (cT3-4a/N +) following NAC were enrolled and a propensity score-matched analysis was performed in a 1:1 manner. The patients were divided into RADG group and LDG group. The clinicopathological characteristics and short-term outcomes were observed.

Results

After propensity score matching, 67 patients each in the RADG and LDG groups. RADG was associated with a lower intraoperative blood loss (35.6 vs. 118.8 ml, P = 0.014) and more retrieved lymph nodes (LNs) (50.7 vs. 39.5, P < 0.001), more extraperigastric (18.3 vs. 10.4, P < 0.001), and suprapancreatic LNs (16.33 vs. 13.70, P = 0.042). The RADG group showed lower VAS scores at postoperative 24 h (2.2 vs 3.3, P = 0.034), earlier ambulation (1.3 vs. 2.6, P = 0.011), aerofluxus time (2.2 vs. 3.6, P = 0.025), and shorter postoperative hospital stay (8.3 vs. 9.8, P = 0.004). There were no significant differences in the operative time (216.7 vs.194.7 min, P = 0.204) and postoperative complications between the two groups.

Conclusion

RADG may be a potential therapeutic option for patients with AGC after NAC considering its advantages in perioperative period compared with LDG.

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Acknowledgements

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Funding

This work was supported by the Cultivating Outstanding Talents Project of Hebei Provincial Government Fund (Grant No. 2019012); Hebei public health committee county-level public hospitals suitable health technology promotion and storage project (Grant No. 2019024); Hebei Medical University Education and Teaching Research Project (Grant No. 2020CGPY-12, Grant No. 2020CHYB-23); and Hebei University Science and Technology Research Project (Grant No. ZD2019139).

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Authors and Affiliations

  1. The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China

    Yuan Tian, Honghai Guo, Yiyang Hu, Peigang Yang, Yang Liu, Ze Zhang, Pingan Ding, Tao Zheng, Liqiao Fan, Zhidong Zhang, Yong Li & Qun Zhao

  2. Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China

    Yuan Tian, Honghai Guo, Yiyang Hu, Peigang Yang, Yang Liu, Ze Zhang, Pingan Ding, Tao Zheng, Liqiao Fan, Zhidong Zhang, Yong Li & Qun Zhao

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  1. Yuan Tian
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Correspondence to Qun Zhao.

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Disclosures

Yuan Tian, Honghai Guo, Yiyang Hu, Peigang Yang, Yang Liu, Ze Zhang, Pingan Ding, Tao Zheng, Liqiao Fan, Zhidong Zhang, Yong Li, and Qun Zhao have no conflicts of interest or financial ties to disclose.

Ethical approval

The present study was approved by the Ethical Review Committee of Hebei Medical University (Shijiazhuang, China, No.2022042). 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., Guo, H., Hu, Y. et al. Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. Surg Endosc 37, 6761–6770 (2023). https://doi.org/10.1007/s00464-023-10122-w

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