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Short-Term Surgical Outcomes of Robotic Gastrectomy Compared to Open Gastrectomy for Patients with Gastric Cancer: a Randomized Trial

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Robotic gastrectomy (RG) has been shown to be a safe and feasible method in gastric cancer (GC) treatment. However, most studies are in Eastern cohorts and there is great interest in knowing whether the method can be used routinely, especially in the West.

Objectives

The aim of this study was to compare the short-term surgical outcomes of D2-gastrectomy by RG versus open gastrectomy (OG).

Methods

Single-institution, open-label, non-inferiority, randomized clinical trial performed between 2015 and 2020. GC patients were randomized (1:1 allocation) to surgical treatment by RG or OG. Da Vinci Si platform was used. Inclusion criteria: gastric adenocarcinoma, stage cT2-4 cN0-1, potentially curative surgery, age 18–80 years, and ECOG performance status 0–1. Exclusion criteria: emergency surgery and previous gastric or major abdominal surgery. Primary endpoint was short-term surgical outcomes. The study is registered at clinicaltrials.gov (NCT02292914).

Results

Of 65 randomized patients, 5 were excluded (3 palliatives, 1 obstruction and emergency surgery, and 1 for material shortage). Consequently, 31 and 29 patients were included for final analysis in the OG and RG groups, respectively. No differences were observed between groups regarding age, sex, BMI, comorbidities, ASA, and frequency of total gastrectomy. RG had similar mean number of harvested lymph nodes (p = 0.805), longer surgical time (p < 0.001), and less bleeding (p < 0.001) compared to OG. Postoperative complications, length of hospital stay, and readmissions in 30 days were equivalent between OG and RG.

Conclusions

RG reduces operative bleeding by more than 50%. The short-term outcomes were non-inferior to OG, although surgical time was longer in RG.

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References

  1. Lee HJ, Hyung WJP, Yang, HK, Han SU, Park YK, al. The 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). Annals of Surgery. 2019;270(6):983–991.

  2. Katai, H., Sasako, M., Fukuda, H. Nakamura K, Hiki N, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 2010;13(4):238–44.

  3. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, et al. 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 (KLASS01). Ann Surg. 2016;263(1):28-35.

    Article  PubMed  Google Scholar 

  4. Hu Y, Huang C, Sun Y, Su X, Cao H, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016;34(12):1350-1357.

    Article  PubMed  Google Scholar 

  5. Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, et al. 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. 2017;20(4):699-708.

    Article  PubMed  Google Scholar 

  6. Kim HH, Han SU, Kim MC, Kim W, Lee HJ, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer. JAMA Oncology. 2019;5:506–513.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Huang C, Liu H, Hu Y, Sun Y, Xiangqian Su X, et al. Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer: Five-Year Outcomes From the CLASS-01 Randomized Clinical Trial. JAMA Surg. 2022;157(1):9-17.

    Article  PubMed  Google Scholar 

  8. Bobo Z, Xin W, Jiang L, Quan W, Liang B, et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies. Surg Endosc. 2019;33(4):1033-1048.

    Article  PubMed  Google Scholar 

  9. Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, et al. Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma. Ann Surg. 2016;263(1):103-9.

    Article  PubMed  Google Scholar 

  10. Ma J, Li X, Zhao S, Zhang R, Yang D. Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis. World Journal of Surgical Oncology. 2020;18(306):1-13.

    Google Scholar 

  11. Kang SY, Lee SY, Kim CY, Yang DH. Comparison of learning curves and clinical outcomes between laparoscopy-assisted distal gastrectomy and open distal gastrectomy. Journal of Gastric Cancer. 2010;10(4):247-53.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Waki Y, Makuuchi R, Nagata M, Furukawa K, Fujiya K, et al. The Current Status and Future Perspective about Robotic Surgery for Gastric Cancer. Gan To Kagaku Ryoho. 2018;45(12):1690-1695.

    PubMed  Google Scholar 

  13. Marano L, D’Ignazio A, Resca L, Marrelli D, Roviello F. Robotic-assisted gastrectomy for gastric cancer: single Western center results. Updates in Surgery. 2021;73(3):865–872.

    Article  PubMed  Google Scholar 

  14. Lu J, Zheng CH, Xu BB, Xie JW, Wang JB, et al. Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. Ann Surg. 2021;273(5):858-867.

    Article  PubMed  Google Scholar 

  15. Ojima T, Nakamura M, Hayata K, Kitadani J, Katsuda M, et al. Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer: A Randomized Clinical Trial. JAMA Surg. 2021;156(10):954-963.

    Article  PubMed  Google Scholar 

  16. Ramos MFKP, Pereira MA, Yagi OK, Dias AR, Charruf AZ, et al. Surgical treatment of gastric cancer: a 10-year experience in a high-volume university hospital. Clinics. 2018;73(1):e543s.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24:1–21.

  18. Dias AR, Ramos MFKP, Szor DJ, Abdalla R, Barchi L, et al. Robotic gastrectomy: Technique standardization. ABCD Arq Bras Cir Dig. 2020;33(3):e1542.

    Article  Google Scholar 

  19. Dias AR, Pereira MA, Mello ES, Zilberstein B, Cecconello I, Ribeiro Junior U. Carnoy's solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial. Gastric Cancer. 2016;19(1):136-42.

    Article  CAS  PubMed  Google Scholar 

  20. In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T. Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database. Ann Surg Oncol. 2017;24(12):3683–3691.

  21. Clavien, PA., Barkun, J, de Oliveira, ML, Vauthey, JN, Dindo, D, et al. The Clavien-Dindo Classification of Surgical Complications, Ann Surg. 2009;250(2):187-96.

    Article  PubMed  Google Scholar 

  22. Yasunaga H, Horiguchi H, Kuwabara K, Matsuda S, Fushimi K, et al. Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer: a propensity-matched analysis. Ann Surg. 2013;257(4):640-646.

    Article  PubMed  Google Scholar 

  23. Kim MS, Kim WJ, Hyung WJ, Kim HI, Han SU, et al. Comprehensive Learning Curve of Robotic Surgery, Annals of Surgery. 2021;273(5):949-956.

    Article  PubMed  Google Scholar 

  24. Chen L, Wang Q, Liu Y, Wang Y, Li Y, et al. A meta-analysis of robotic gastrectomy versus open gastrectomy in gastric cancer treatment. Asian Journal of Surgery. 2022;45:698-706.

    Article  PubMed  Google Scholar 

  25. Martin AN, Das D, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors. J Gastrointest Surg. 2016;20(9):1554-64.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Papenfuss WA, Kukar M, Oxenberg J, Attwood K, Nurkin S, et al. Morbidity and Mortality Associated with Gastrectomy for Gastric Cancer. Ann Surg Oncol. 2014;21(9):3008-14.

    Article  PubMed  Google Scholar 

  27. Zhang Y, Hedo R, Rivera A, Rull R, Richardson S, Tu XM. Post hoc power analysis: is it an informative and meaningful analysis? Gen Psychiatr. 2019; 32(4): e100069.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Aiolfi A, Lombardo F, Matsushima K, Sozzi A, Cavalli M, et al. Systematic review and updated network meta-analysis of randomized controlled trials comparing open, laparoscopic-assisted, and robotic distal gastrectomy for early and locally advanced gastric cancer. Surgery 2021;170(3):942-51.

    Article  PubMed  Google Scholar 

  29. Jiang X, Hiki N, Nunobe S, Kumagai K, Nohara K, et al. Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer. Ann Surg Oncol 2012;19(1):115-21.

    Article  PubMed  Google Scholar 

  30. Park JM, Jin SH, Lee SR, Kim H, Jung IH, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases. Surg Endosc. 2008;22(10):2133-9.

    Article  PubMed  Google Scholar 

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Acknowledgements

This research project was partially funded by the Ministry of Health’s Science and Technology Department. The authors thank them for their support in conducting this clinical trial in gastric cancer.

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Authors and Affiliations

  1. Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (ICESP- HCFMUSP), Av. Dr. Arnaldo, 251. 4th floor. Cerqueira Cesar, São Paulo, SP, 01246-000, Brazil

    Ulysses Ribeiro Jr, André Roncon Dias, Marcus Fernando Kodama Pertille Ramos, Osmar Kenji Yagi, Rodrigo José Oliveira, Marina Alessandra Pereira, Ricardo Zugaib Abdalla, Bruno Zilberstein, Sérgio Carlos Nahas & Ivan Cecconello

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  1. Ulysses Ribeiro Jr
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  10. Ivan Cecconello
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Contributions

Ulysses Ribeiro Jr, André R. Dias, Marcus F.K.P. Ramos: study design, data retrieval, statistical analysis, draft of the manuscript. Osmar K. Yagi, Rodrigo Jose Oliveira, Marina A. Pereira: data retrieval, review of the manuscript. Ricardo Zugaib Abdalla, Bruno Zilberstein, Sérgio C. Nahas, Ivan Cecconello: critical analysis, review of the manuscript.

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Correspondence to Ulysses Ribeiro Jr.

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Oral presentation at Digestive Disease Week—Plenary Session, 2022, San Diego, USA.

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Ribeiro, U., Dias, A.R., Ramos, M.F.K.P. et al. Short-Term Surgical Outcomes of Robotic Gastrectomy Compared to Open Gastrectomy for Patients with Gastric Cancer: a Randomized Trial. J Gastrointest Surg 26, 2477–2485 (2022). https://doi.org/10.1007/s11605-022-05448-0

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