Skip to main content

Advertisement

SpringerLink
Log in

Comparison of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The benefits of robotic gastrectomy (RG) over laparoscopic gastrectomy (LG) remain controversial. This single-center, propensity score-matched study aimed to compare the outcomes of RG with those of LG for treating gastric cancer.

Methods

We searched the prospective gastric cancer database of our institute for patients with gastric cancer who underwent RG or LG between January 2014 and December 2019, excluding patients with remnant stomach cancer and those who underwent concurrent surgery for comorbid malignancies. One-to-one propensity score matching was performed to reduce bias from confounding patient-related variables, and short- and long-term outcomes were compared between the groups.

Results

We identified 1189 patients who underwent LG (n = 979) or RG (n = 210). After propensity score matching, we selected 210 pairs of patients who underwent LG (distal gastrectomy, 138; total or proximal gastrectomy, 72) or RG (distal gastrectomy, 143; total or proximal gastrectomy, 67). RG was associated with a significantly shorter operative time (RG = 201 min vs. LG = 231 min, p = 0.0051), less blood loss (RG = 13 mL vs. LG = 42 mL, p < 0.0001), lower postoperative morbidity (RG = 1.0% vs. LG = 4.8%, p = 0.0066), and a shorter postoperative hospital stay (p = 0.0002) than LG. Drain amylase levels on postoperative Days 1 and 3 in the RG group were significantly lower than those in the LG group (p < 0.0001).

Conclusions

RG is a safe and feasible treatment for gastric cancer, with a shorter operative time, less blood loss, and lower postoperative morbidity than LG. The application of robotics in minimally invasive gastric cancer surgery may offer an alternative to conventional surgery. Multicenter, prospective, randomized controlled trials comparing RG with conventional LG are needed to establish the feasibility and efficacy of minimally invasive gastric cancer surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    PubMed  Google Scholar 

  2. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    CAS  PubMed  Google Scholar 

  3. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131(Supplement):S306–S311

    Article  PubMed  Google Scholar 

  4. Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S, Fukushima N, Yasuda T, Asao Y, Fujiwara Y, Sasako M (2017) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan clinical oncology group study JCOG0912. Gastric Cancer 20:699–708

    Article  PubMed  Google Scholar 

  5. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee HJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35

    Article  PubMed  Google Scholar 

  6. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727

    Article  PubMed  Google Scholar 

  7. Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–1258

    Article  PubMed  Google Scholar 

  8. Katai H, Mizusawa J, Katayama H, Morita S, Yamada T, Bando E, Ito S, Takagi M, Takagane A, Teshima S, Koeda K, Nunobe S, Yoshikawa T, Terashima M, Sasako M (2020) 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 5:142–151

    Article  PubMed  Google Scholar 

  9. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741

    Article  PubMed  Google Scholar 

  10. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357

    Article  PubMed  Google Scholar 

  11. Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ, Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group (2019) 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 5:506–513

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hyung WJ, Yang HK, Park YK, Lee HJ, An JY, Kim W, Kim HI, Kim HH, Ryu SW, Hur H, Kim MC, Kong SH, Cho GS, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Han SU, Korean Laparoendoscopic Gastrointestinal Surgery Study Group (2020) Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial. J Clin Oncol 38:3304–3313

    Article  PubMed  Google Scholar 

  13. Guerra F, Giuliani G, Iacobone M, Bianchi PP, Coratti A (2017) Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery. Surg Endosc 31:4346–4356

    Article  PubMed  Google Scholar 

  14. Hiki N, Honda M, Etoh T, Yoshida K, Kodera Y, Kakeji Y, Kumamaru H, Miyata H, Yamashita Y, Inomata M, Konno H, Seto Y, Kitano S (2018) Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer 21:162–170

    Article  PubMed  Google Scholar 

  15. Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, Honda M, Miyata H, Yamashita Y, Seto Y, Kitano S, Konno H (2019) Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 22:202–213

    Article  PubMed  Google Scholar 

  16. Hashizume M, Sugimachi K (2003) Robot-assisted gastric surgery. Surg Clin North Am 83:1429–1444

    Article  PubMed  Google Scholar 

  17. Coratti A, Annecchiarico M, Bonapasta SA (2015) Robotic surgery: current applications and new trends. Springer, Milan

    Google Scholar 

  18. Coratti A, Annecchiarico M, Di Marino M, Gentile E, Coratti F, Giulianotti PC (2013) Robot-assisted gastrectomy for gastric cancer: current status and technical considerations. World J Surg 37:2771–2781

    Article  PubMed  Google Scholar 

  19. Wang G, Jiang Z, Zhao J, Liu J, Zhang S, Zhao K, Feng X, Li J (2016) Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer: a randomized clinical trial. J Surg Oncol 113:397–404

    Article  PubMed  Google Scholar 

  20. Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, Park JM, An JY, Kim MC, Park S, Song KY, Oh SJ, Kong SH, Suh BJ, Yang DH, Ha TK, Kim YN, Hyung WJ (2016) Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg 263:103–109

    Article  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  22. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma 3rd English ed. Gastric Cancer 14:101–112

    Article  Google Scholar 

  23. Hamabe A, Omori T, Tanaka K, Nishida T (2012) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 26:1702–1709

    Article  PubMed  Google Scholar 

  24. Omori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, Kishi K, Miyoshi N, Tomokuni A, Akita H, Takahashi H, Kobayashi S, Yasui M, Ohue M, Yano M, Sakon M (2016) Comparison of single-incision and conventional multi-port laparoscopic distal gastrectomy with D2 lymph node dissection for gastric cancer: a propensity score-matched analysis. Ann Surg Oncol 23:817–824

    Article  PubMed  Google Scholar 

  25. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Article  Google Scholar 

  26. Ushimaru Y, Omori T, Fujiwara Y, Yanagimoto Y, Sugimura K, Yamamoto K, Moon JH, Miyata H, Ohue M, Yano M (2019) The feasibility and safety of preoperative fluorescence marking with indocyanine green (ICG) in laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg 23:468–476

    Article  PubMed  Google Scholar 

  27. Omori T, Masuzawa T, Akamatsu H, Nishida T (2014) A simple and safe method for Billroth I reconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg 18:613–616

    Article  PubMed  Google Scholar 

  28. Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–e17

    Article  PubMed  Google Scholar 

  29. Lu J, Zheng CH, Xu BB, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Huang CM, Li P (2021) Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial. Ann Surg 273:858–867

    Article  PubMed  Google Scholar 

  30. Chen K, Pan Y, Zhang B, Maher H, Wang XF, Cai XJ (2017) Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg 17:93

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bobo Z, Xin W, Jiang L, Quan W, Liang B, Xiangbing D, Ziqiang W (2019) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies. Surg Endosc 33:1033–1048

    Article  PubMed  Google Scholar 

  32. Uyama I, Suda K, Nakauchi M, Kinoshita T, Noshiro H, Takiguchi S, Ehara K, Obama K, Kuwabara S, Okabe H, Terashima M (2019) Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer 22:377–385

    Article  PubMed  Google Scholar 

  33. Shibasaki S, Suda K, Nakauchi M, Nakamura K, Kikuchi K, Inaba K, Uyama I (2020) Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: a single-center, retrospective and propensity score-matched analysis. World J Gastroenterol 26:1172–1184

    Article  PubMed  PubMed Central  Google Scholar 

  34. Okabe H, Obama K, Tsunoda S, Matsuo K, Tanaka E, Hisamori S, Sakai Y (2019) Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer. Surg Today 49:820–827

    Article  PubMed  Google Scholar 

  35. Tokunaga M, Makuuchi R, Miki Y, Tanizawa Y, Bando E, Kawamura T, Terashima M (2016) Late phase II study of robot-assisted gastrectomy with nodal dissection for clinical stage I gastric cancer. Surg Endosc 30:3362–3367

    Article  PubMed  Google Scholar 

  36. Shibasaki S, Suda K, Obama K, Yoshida M, Uyama I (2020) Should robotic gastrectomy become a standard surgical treatment option for gastric cancer? Surg Today 50:955–965

    Article  PubMed  Google Scholar 

  37. Wang WJ, Li HT, Yu JP, Su L, Guo CA, Chen P, Yan L, Li K, Ma YW, Wang L, Hu W, Li YM, Liu HB (2019) Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study. Surg Endosc 33:3341–3354

    Article  PubMed  Google Scholar 

  38. Ojima T, Nakamura M, Hayata K, Kitadani J, Katsuda M, Takeuchi A, Tominaga S, Nakai T, Nakamori M, Ohi M, Kusunoki M, Yamaue H (2021) Short-term outcomes of robotic gastrectomy vs laparoscopic gastrectomy for patients with gastric cancer: a randomized clinical trial. JAMA Surg 156:954–963

    Article  PubMed  Google Scholar 

  39. Kurokawa Y, Takeuchi H, Doki Y, Mine S, Terashima M, Yasuda T, Yoshida K, Daiko H, Sakuramoto S, Yoshikawa T, Kunisaki C, Seto Y, Tamura S, Shimokawa T, Sano T, Kitagawa Y (2021) Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg 274:120–127

    Article  PubMed  Google Scholar 

  40. Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, Okumura Y, Sano T, Yamaguchi T (2017) “Pancreas-compressionless gastrectomy”: a novel laparoscopic approach for suprapancreatic lymph node dissection. Ann Surg Oncol 24:3331–3337

    Article  PubMed  Google Scholar 

  41. Hikage M, Tokunaga M, Makuuchi R, Irino T, Tanizawa Y, Bando E, Kawamura T, Terashima M (2018) Comparison of surgical outcomes between robotic and laparoscopic distal gastrectomy for cT1 gastric cancer. World J Surg 42:1803–1810

    Article  PubMed  Google Scholar 

  42. Suda K, Man-I M, Ishida Y, Kawamura Y, Satoh S, Uyama I (2015) Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 29:673–685

    Article  PubMed  Google Scholar 

  43. Liu H, Kinoshita T, Tonouchi A, Kaito A, Tokunaga M (2019) What are the reasons for a longer operation time in robotic gastrectomy than in laparoscopic gastrectomy for stomach cancer? Surg Endosc 33:192–198

    Article  PubMed  Google Scholar 

  44. Hyun MH, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH, Kim JH, Park SH, Mok YJ, Park SS (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20:1258–1265

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Takeshi Omori, Kazuyoshi Yamamoto, Hisashi Hara, Naoki Shinno, Masaaki Yamamoto, Kohei Fujita, Takashi Kanemura, Tomohira Takeoka, Hirofumi Akita, Hiroshi Wada, Masayoshi Yasui, Chu Matsuda, Junichi Nishimura, Yoshiyuki Fujiwara, Hiroshi Miyata, Masayuki Ohue & Masato Sakon

Authors
  1. Takeshi Omori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuyoshi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hisashi Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoki Shinno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaaki Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kohei Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Kanemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomohira Takeoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hirofumi Akita
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroshi Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masayoshi Yasui
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Chu Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Junichi Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yoshiyuki Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Hiroshi Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Masayuki Ohue
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Masato Sakon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeshi Omori.

Ethics declarations

Disclosures

Drs. Takeshi Omori, Kazuyoshi Yamamoto, Hisashi Hara, Naoki Shinno, Masaaki Yamamoto, Kouhei Fujita, Takashi Kanemura, Tomohira Takeoka, Hirofui Akita, Hiroshi Wada, Masayoshi Yasui, Chu Matsuda, Junichi Nishimura, Yoshiyuki Fujiwara, Hiroshi Miyata, Masayuki Ohue, and Masato Sakon have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Omori, T., Yamamoto, K., Hara, H. et al. Comparison of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 36, 6223–6234 (2022). https://doi.org/10.1007/s00464-022-09125-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09125-w

Keywords

Search

Navigation