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Effectiveness and safety of robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis of 12,401 gastric cancer patients

Abstract

Advanced minimally invasive techniques, such as robotic surgeries, are applied increasingly frequently around the world and are primarily used to improve the surgical outcomes of laparoscopic gastrectomy (LG). Against that background, we conducted a meta-analysis to evaluate the feasibility, safety, and effectiveness of robotic gastrectomy (RG). Studies comparing surgical outcomes between LG and RG patients were retrieved from medical databases, including RCTs and non-RCTs. The primary outcome of this study was overall survival, which was obtained by evaluating the 3-year survival rate and the 5-year survival rate. In addition, postoperative complications, mortality, length of hospital stay, and harvested lymph nodes were also assessed. We also conducted subgroup analyses stratified by resection type, body mass index, age, depth of invasion and tumour size. Ultimately, 31 articles met the criterion for our study through an attentive check of each text, including 1 RCT and 30 non-RCTs. A total of 12,401 patients were included in the analysis, with 8127 (65.5%) undergoing LG and 4274 (34.5%) undergoing RG. Compared with LG, RG was associated with fewer postoperative complications (OR 0.81; 95% CI 0.71–0.93; P = 0.002), especially pancreas-related complications (OR 0.376; 95% CI 0.156–0.911; P = 0.030), increased harvested lymph nodes (WMD 2.03; 95% CI 0.95–3.10; P < 0.001), earlier time to first flatus (WMD − 0.105 days; 95% CI − 0.207 to − 0.003; P = 0.044), longer operation time (WMD 40.192 min, 95% CI 32.07–48.31; P < 0.001), less intraoperative blood loss (WMD − 20.09 ml; 95% CI − 26.86 to − 13.32; P < 0.001), and higher expense (WMD 19,141.68 RMB; 95% CI 11,856.07–26,427.29; P < 0.001). There was no significant difference between RG and LG regarding 3-year overall survival (OR 1.030; 95% CI 0.784–1.353; P = 0.832), 5-year overall survival (OR 0.862; 95% CI 0.721–1.031; P = 0.105), conversion rate (OR 0.857; 95% CI 0.443–1.661; P = 0.648), postoperative hospital stay (WMD − 0.368 days; 95% CI − 0.75–0.013; P = 0.059), mortality (OR 1.248; 95% CI 0.514–3.209; P = 0.592), and reoperation (OR 0.855; 95% CI 0.479–1.525; P = 0.595). Our study revealed that postoperative complications, especially pancreas-related complications, occurred less often with RG than with LG. However, long-term outcomes between the two surgical techniques need to be further examined, particularly regarding the oncological adequacy of robotic gastric cancer resections.

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Data availability

All data generated or analysed during this study are included in this published article.

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Acknowledgements

We thank Peng-bo Yu of Jiangnan University, who majored in translation studies, for revising the language of this article.

Funding

Domestic support from (1) National Natural Science Foundation of China (No. 81772547); (2) the Fundamental Research Funds for the Central Universities (No. 2017SCU04A18); (3) Young Scientific and Academic Leaders Training Program of Sichuan University (No. 0082604151001/035); (4) Foundation of Science & Technology Department of Sichuan Province (No. 2019YFS0256); (5) 1. 3. 5 Projects for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZY2017304).

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Contributions

Study conception and design: TJ, H-DL, J-KH, and KY; Acquisition of data: TJ, H-DL, J-KH, and KY; Analysis and interpretation of data: TJ, H-DL, J-KH, and KY; Drafting of manuscript: TJ, J-KH, KY, and Z-HC; Critical revision: TJ, J-KH, KY, and Y-XZ; Approval of final manuscript: all authors.

Corresponding author

Correspondence to Kun Yang.

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Jin, T., Liu, HD., Yang, K. et al. Effectiveness and safety of robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis of 12,401 gastric cancer patients. Updates Surg (2021). https://doi.org/10.1007/s13304-021-01176-3

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Keywords

  • Robotic gastrectomy
  • Laparoscopic gastrectomy
  • Meta-analysis
  • Overall morbidity
  • Pancreas-related complications
  • Stomach neoplasms