Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

Amilcare Parisi, Daniel Reim, Felice Borghi, Ninh T. Nguyen, Feng Qi, Andrea Coratti, Fabio Cianchi, Maurizio Cesari, Francesca Bazzocchi, Orhan Alimoglu, Johan Gagnière, Graziano Pernazza, Simone D'Imporzano, Yan Bing Zhou, Juan Santiago Azagra, Olivier Facy, Steven T. Brower, Zhi Wei Jiang, Zang Lu, Arda IsikAlessandro Gemini, Stefano Trastulli, Alexander Novotny, Alessandra Marano, Tong Liu, Mario Annecchiarico, Benedetta Badii, Giacomo Arcuri, Andrea Avanzolini, Metin Leblebici, Denis Pezet, Shou Gen Cao, Martine Goergen, Zhang Shu, Giorgio Palazzini, Vito D'Andrea, Jacopo Desiderio

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes. METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided. RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups. CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Original languageEnglish
Pages (from-to)2376-2384
Number of pages9
JournalWorld Journal of Gastroenterology
Volume23
Issue number13
DOIs
StatePublished - 7 Apr 2017
Externally publishedYes

Keywords

  • Gastrectomy
  • Gastric cancer
  • Laparoscopy
  • Minimally invasive surgery
  • Robot-assisted
  • Robotic

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