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Short-Term and Textbook Surgical Outcomes During the Implementation of a Robotic Gastrectomy Program

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Whether gastric cancer patients derive greater benefit from robotic gastrectomy (RG), or open gastrectomy (OG) is unknown. We initiated a RG program in 2018, with prospective short-term outcome monitoring to ensure safety. We hypothesized that the RG program for gastric cancer can be safely implemented with equivalent safety and oncological textbook outcomes (TOs) to conventional open gastrectomy (OG).

Methods

The study included patients who underwent curative-intent OG or RG for gastric adenocarcinoma between January 2018 and December 2021. TO metrics were negative surgical margins, ≥ 15 lymph nodes examined, no severe (Clavien–Dindo grade ≥ IIIa) postoperative complications, no reinterventions within 90 days after surgery, no ICU admission, no prolonged length of stay (LOS; > 10 days), no 90-day postoperative mortality, and no readmission within 90 days after surgery. Overall TO was achieved when all these metrics were met.

Results

Of 161 patients, 120 underwent OG, and 41 underwent RG. The two groups’ demographic and disease characteristics did not differ significantly. Compared with OG patients, RG patients had a longer median surgery time (348 vs. 282 min), smaller median blood loss volume (50 vs. 150 mL), lower mean prescribed opioid dose at discharge (12 vs. 45 mg), and shorter median LOS (4 vs. 7 days; all p < 0.001). The groups’ postoperative complication rates (10% vs. 17%) did not differ significantly (p = 0.283). The overall TO rate of the RG group (73%) was higher than that of the OG group (60%), but the difference was not significant (p = 0.131).

Conclusion

We were able to implement the RG program safely, without compromising safety or oncological outcomes.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank Joe Munch in MD Anderson’s Research Medical Library for editing the manuscript.

Funding

Supported by the NIH/NCI under award number P30CA016672.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA

    Yuki Hirata, Annamaria Agnes, Elsa M. Arvide, Kristen A. Robinson, Connie To, Heather L. Griffith, Madison D. LaRose, Paul Mansfield, Brian D. Badgwell & Naruhiko Ikoma

  2. Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kathryn M. Munder

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  1. Yuki Hirata
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Correspondence to Naruhiko Ikoma.

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Ethics Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and regional) and with the Helsinki Declaration of 1975, as revised in 1983. Because this was a retrospective study of de-identified patients, no informed consent was required. Ethics approval for this work was obtained.

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NI has received a research grant from Intuitive Surgical. Remaining authors claim no conflict of interest.

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Presentation: This work has been presented at the 130th Western Surgical Association Annual Meeting in Santa Barbara, CA, Nov. 5-8, 2022.

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Hirata, Y., Agnes, A., Arvide, E.M. et al. Short-Term and Textbook Surgical Outcomes During the Implementation of a Robotic Gastrectomy Program. J Gastrointest Surg 27, 1089–1097 (2023). https://doi.org/10.1007/s11605-023-05627-7

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