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Propensity Score-Matched Analysis of the Short- and Long-Term Outcomes of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Robotic gastrectomy (RG) has been rapidly adopted for gastric cancer (GC) treatment. However, the benefits of RG over laparoscopic gastrectomy (LG) for GC remain unclear.

Methods

A total of 451 patients who underwent either RG (n = 83) or LG (n = 368) for GC were enrolled in this study. A 1:1 matched, propensity score-matched analysis was performed using the following factors: age, sex, body mass index, pT, pN, pStage, tumor location, vessel invasion, tumor markers, surgical procedure, reconstruction method, extent of lymphadenectomy, and Endoscopic Surgical Skill Qualification System qualified surgeon as an operator. The surgical outcomes of the two groups were compared.

Results

A well-balanced cohort of 158 patients was analyzed (n = 79 in the RG group, n = 79 in the LG group). Regarding the short-term outcomes, the respective blood loss volume, drain amylase content, and number of retrieved lymph nodes in the RG and LG groups were 38.62 ± 73.06 ml and 67.53 ± 108.20 ml (p < 0.05), 450 ± 371 IU/l and 1590 ± 6392 IU/l (p < 0.01), and 35.02 ± 15.51 and 25.28 ± 11.70 (p < 0.01). The morbidity rate was similar between the RG and LG groups (not significant [NS]). Regarding the long-term survival outcomes, there were no intergroup differences in 3-year overall survival (91.72% in the RG group vs. 83.39% in the LG group: NS) and 3-year, disease-free survival (93.31% in the vs. 90.44%: NS).

Conclusions

RG was safe and contributed to better short-term outcomes and similar long-term survival outcomes compared with LG.

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References

  1. Terashima M. The 140 years’ journey of gastric cancer surgery: from the two hands of Billroth to the multiple hands of the robot. Ann Gastroenterol Surg. 2021;5(3):270–7.

    Article  Google Scholar 

  2. Kinoshita T, Uyama I, Terashima M, et al. LOC-A Study Group. Long-term outcomes of laparoscopic versus open surgery for clinical stage II/III gastric cancer: a multicenter cohort study in Japan (LOC-A study). Ann Surg. 2019;269(5):887-94.

  3. Katai H, Mizusawa J, Katayama H, et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol. 2020;5(2):142–51.

    Article  Google Scholar 

  4. Lee HJ, Hyung WJ, Yang HK, et al. Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg. 2019;270(6):983-91.

  5. Kim HH, Han SU, Kim MC, et al. Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with Stage I gastric cancer: The KLASS-01 Randomized Clinical Trial. JAMA Oncol. 2019;5(4):506-13.

  6. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4(2):146-8. Erratum in: Surg Laparosc Endosc. 2013;23(5):480.

  7. Hashizume M, Sugimachi K. Robot-assisted gastric surgery. Surg Clin North Am. 2003;83(6):1429–44.

    Article  Google Scholar 

  8. Uyama I, Suda K, Nakauchi M, et al. Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer. 2019;22(2):377–85.

    Article  Google Scholar 

  9. Lu J, Zheng CH, Xu BB, et al. Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial. Ann Surg. 2021;273(5):858–67.

    Article  Google Scholar 

  10. Kim HI, Han SU, Yang HK, et al. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg. 2016;263(1):103–9.

    Article  Google Scholar 

  11. Guerrini GP, Esposito G, Magistri P, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: the largest meta-analysis. Int J Surg. 2020;82:210–28.

    Article  Google Scholar 

  12. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009;249(6):927–32.

    Article  Google Scholar 

  13. Shibasaki S, Suda K, Obama K, Yoshida M, Uyama I. Should robotic gastrectomy become a standard surgical treatment option for gastric cancer? Surg Today. 2020;50(9):955–65.

    Article  Google Scholar 

  14. Park JM, Kim HI, Han SU, et al. Who may benefit from robotic gastrectomy? A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy. Eur J Surg Oncol. 2016;42(12):1944–9.

    Article  CAS  Google Scholar 

  15. Suda K, Man-I M, Ishida Y, Kawamura Y, Satoh S, Uyama I. Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc. 2015;29(3):673–85.

    Article  Google Scholar 

  16. Kim JW. After propensity score matching in long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer. 2018;21(6):1071.

    Article  Google Scholar 

  17. 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. 2021:1-11.

  18. Liao G, Zhao Z, Khan M, Yuan Y, Li X. Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients. World J Surg Oncol. 2019;17(1):86.

    Article  Google Scholar 

  19. Obama K, Kim YM, Kang DR, et al. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer. 2018;21(2):285–95.

    Article  Google Scholar 

  20. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 3rd English edn. Gastric Cancer. 2011;14:101-12.

  21. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018, 5th edn. Gastric Cancer. 2021;24:1-21.

  22. Kamikawa Y, Kobayashi T, Kamiyama S, et al. A new procedure of esophagogastrostomy to prevent reflux following proximal gastrectomy (in Japanese). Shoukakigeka. 2001;24:1053–60.

    Google Scholar 

  23. Mine S, Nunobe S, Watanabe M. A novel technique of anti-reflux esophagogastrostomy following left thoracoabdominal esophagectomy for carcinoma of the esophagogastric junction. World J Surg. 2015;39(9):2359–61.

    Article  Google Scholar 

  24. Yamashita Y, Yamamoto A, Tamamori Y, Yoshii M, Nishiguchi Y. Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy. Gastric Cancer. 2017;20(4):728–35.

    Article  Google Scholar 

  25. Nishi M, Shimada M, Yoshikawa K, et al. Advantages of the left-handed ultrasonic shears technique for robotic gastrectomy. Surg Laparosc Endosc Percutan Tech. 2021. https://doi.org/10.1097/SLE.0000000000000923.

    Article  PubMed  Google Scholar 

  26. Gómez Ruiz M, Lainez Escribano M, Cagigas Fernández C, Cristobal Poch L, Santarrufina Martínez S. Robotic surgery for colorectal cancer. Ann Gastroenterol Surg. 2020;4(6):646–51.

    Article  Google Scholar 

  27. Leal Ghezzi T, Campos Corleta O. 30 years of robotic surgery. World J Surg. 2016;40(10):2550–7.

    Article  Google Scholar 

  28. Yu J, Huang C, Sun Y, et al. Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA. 2019;321(20):1983-92.

  29. Ojima T, Nakamura M, Nakamori M, et al. Robotic versus laparoscopic gastrectomy with lymph node dissection for gastric cancer: study protocol for a randomized controlled trial. Trials. 2018;19(1):409.

    Article  Google Scholar 

  30. Cui H, Cao B, Liu G, et al. Comparison of short-term outcomes and quality of life in totally laparoscopic distal gastrectomy and totally robotic distal gastrectomy for clinical stage I-III gastric cancer: study protocol for a multi-institutional randomised clinical trial. BMJ Open. 2021;11(5):e043535.

    Article  Google Scholar 

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Acknowledgments

The authors thank Kelly Zammit, BVSc, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Tokushima Graduate School, Kuramoto-cho, Tokushima, Japan

    Masaaki Nishi MD, PhD, FACS, Mistuo Shimada MD, Kozo Yoshikawa MD, Chie Takasu MD, Yuma Wada MD, Takuya Tokunaga MD, Toshihiro Nakao MD, Hideya Kashihara MD, Toshiaki Yoshimoto MD & Shoko Yamashita MD

Authors
  1. Masaaki Nishi MD, PhD, FACS
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  2. Mistuo Shimada MD
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  3. Kozo Yoshikawa MD
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  4. Chie Takasu MD
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  9. Toshiaki Yoshimoto MD
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Corresponding author

Correspondence to Masaaki Nishi MD, PhD, FACS.

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Disclosures

Masaaki Nishi, Mistuo Shimada, Kozo Yoshikawa, Takuya Tokunaga, Toshihiro Nakao, Chie Takasu, Hideya Kashihara, Yuma Wada, Toshiaki Yoshimoto, and Shoko Yamashita declare no conflicts of interest for this article.

Ethical Standards

The protocol for this research project was approved by the Ethics Committee of Tokushima University (approval no. 3215-1). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. All informed consent was obtained from the subject(s) and/or guardian(s).

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Nishi, M., Shimada, M., Yoshikawa, K. et al. Propensity Score-Matched Analysis of the Short- and Long-Term Outcomes of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer. Ann Surg Oncol 29, 3887–3895 (2022). https://doi.org/10.1245/s10434-021-11203-7

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  • DOI: https://doi.org/10.1245/s10434-021-11203-7

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