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Robot-assisted versus laparoscopic-assisted gastrectomy among malnourished patients with gastric cancer based on textbook outcome

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Abstract

Background

Textbook outcome (TO) has been widely employed as a comprehensive indicator to assess the short-term prognosis of patients with cancer. Preoperative malnutrition is a potential risk factor for adverse surgical outcomes in patients with gastric cancer (GC). This study aimed to compare the TO between robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG) in malnourished patients with GC.

Methods

According to the diagnostic consensus of malnutrition proposed by Global Leadership Initiative on Malnutrition (GLIM) and Nutrition Risk Index (NRI), 895 malnourished patients with GC who underwent RAG (n = 115) or LAG (n = 780) at a tertiary referral hospital between January 2016 and May 2021 were included in the propensity score matching (PSM, 1:2) analysis.

Results

After PSM, no significant differences in clinicopathological characteristics were observed between the RAG (n = 97) and LAG (n = 194) groups. The RAG group had significantly higher operative time and lymph nodes harvested, as well as significantly lower blood loss and hospital stay time compared to the LAG group. More patients in the RAG achieved TO. Logistic regression analysis revealed that RAG was an independent protective factor for achieving TO. There were more adjuvant chemotherapy (AC) cycles in the RAG group than in the LAG group. After one year of surgery, a higher percentage of patients (36.7% vs. 22.8%; P < 0.05) in the RAG group recovered from malnutrition compared to the LAG group.

Conclusions

For malnourished patients with GC, RAG performed by experienced surgeons can achieved a higher rate of TO than those of LAG, which directly contributed to better AC compliance and a faster restoration of nutritional status.

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Acknowledgements

We thank those who have devoted a lot to this study, including nurses, pathologists, further-study doctors, statisticians, reviewers and editors. We would like to thank Editage (www.editage.cn) for English language editing. They were not financially compensated for their contributions.

Funding

This study was supported by Joint Funds for the innovation of science and Technology, Fujian province (2021Y9042); Fujian provincial health technology project (2022QNA026).

Author information

Author notes

  1. Guang-Tan Lin and Jun-Yu Chen have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Guang-Tan Lin, Jun-Yu Chen, Zhi-Xin Shang-Guan, Deng-Hui Fan, Qing Zhong, Dong Wu, Zhi-Yu Liu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Ju-Li Lin, Jian-Wei Xie, Ping Li, Chang-Ming Huang & Chao-Hui Zheng

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Guang-Tan Lin, Jun-Yu Chen, Zhi-Xin Shang-Guan, Deng-Hui Fan, Qing Zhong, Dong Wu, Zhi-Yu Liu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Ju-Li Lin, Jian-Wei Xie, Ping Li, Chang-Ming Huang & Chao-Hui Zheng

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Guang-Tan Lin, Jun-Yu Chen, Zhi-Xin Shang-Guan, Deng-Hui Fan, Qing Zhong, Dong Wu, Zhi-Yu Liu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Ju-Li Lin, Jian-Wei Xie, Ping Li, Chang-Ming Huang & Chao-Hui Zheng

  4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Guang-Tan Lin, Jun-Yu Chen, Zhi-Xin Shang-Guan, Deng-Hui Fan, Qing Zhong, Dong Wu, Zhi-Yu Liu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Ju-Li Lin, Jian-Wei Xie, Ping Li, Chang-Ming Huang & Chao-Hui Zheng

  5. Public Technology Service Center, Fujian Medical University, Fuzhou, China

    Zhi-Hong Huang

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  1. Guang-Tan Lin
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Contributions

G-TL: Conceptualization, Methodology, Data acquisition, Quality control of data and algorithms, Formal analysis, and interpretation, Statistical analysis, Writing—original draft, Writing—review &; editing, Manuscript review. J-Y C: Conceptualization, Methodology, Data acquisition, Quality control of data and algorithms, Formal analysis, and interpretation, Statistical analysis, Writing—original draft, Writing—review &; editing, Manuscript review. Z-XS-G: Conceptualization, Methodology, Data acquisition, Quality control of data and algorithms, Formal analysis, and interpretation, Statistical analysis, Writing—original draft, Writing—review &; editing, Manuscript review. D-HF: Methodology, Quality control of data and algorithms, Formal analysis, and interpretation, Manuscript review. QZ: Methodology, Quality control of data and algorithms, Formal analysis, and interpretation, Manuscript review. DW: Formal analysis, and interpretation, Manuscript review. Z-YL: Data acquisition, and interpretation. Y-MJ: Data acquisition, and interpretation. J-BW: Data acquisition, Manuscript review. J-XL: Data acquisition, Manuscript review. JL: Data acquisition, Manuscript review. Q-YC: Data acquisition, Manuscript review. Z-HH: Data acquisition. J-LL: Data acquisition, Manuscript review. J-WX: Methodology, Manuscript review. PL: Conceptualization, Methodology, Data acquisition, Manuscript review. C-MH: Conceptualization, Manuscript review. C-HZ: Conceptualization, Methodology, Manuscript review.

Corresponding authors

Correspondence to Chang-Ming Huang or Chao-Hui Zheng.

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Disclosures

All authors such as Guang-Tan Lin, Jun-Yu Chen, Zhi-Xin Shang-Guan, Deng-Hui Fan, Qing Zhong, Dong Wu, Zhi-Yu Liu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Zhi-Hong Huang, Ju-Li Lin, Jian-Wei Xie, Ping Li, Chang-Ming Huang, Chao-Hui Zheng have no conflict of interest and no potential benefits. The institutional review boards of all the participating institutions approved the study. The authors have no other disclosures to report.

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Supplementary Information

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Supplementary file1 (TIF 194 KB)—Study Flowchart. Flowchart depicting the patient selection process

464_2024_10769_MOESM2_ESM.tif

Supplementary file2 (TIF 36 KB)—Standardized differences before and after propensity score matching. Standardized differences before propensity score matching; B. Standardized differences after propensity score matching

464_2024_10769_MOESM3_ESM.tif

Supplementary file3 (TIF 656 KB)—The distribution of nourishment in RAG and LAG groups. Blue area indicates the proportion of patients with good nutrition. Orange area indicates the proportion of patients with malnutrition

Supplementary file4 (DOC 112 KB)

Supplementary file5 (DOC 160 KB)

Supplementary file6 (DOC 26 KB)

Supplementary file7 (DOC 32 KB)

Supplementary file8 (DOC 36 KB)

Supplementary file9 (DOC 21 KB)

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Lin, GT., Chen, JY., Shang-Guan, ZX. et al. Robot-assisted versus laparoscopic-assisted gastrectomy among malnourished patients with gastric cancer based on textbook outcome. Surg Endosc 38, 2666–2676 (2024). https://doi.org/10.1007/s00464-024-10769-z

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