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Comparative Study
. 2017 Apr 7;23(13):2376-2384.
doi: 10.3748/wjg.v23.i13.2376.

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

Amilcare Parisi  1 , Daniel Reim  1 , Felice Borghi  1 , Ninh T Nguyen  1 , Feng Qi  1 , Andrea Coratti  1 , Fabio Cianchi  1 , Maurizio Cesari  1 , Francesca Bazzocchi  1 , Orhan Alimoglu  1 , Johan Gagnière  1 , Graziano Pernazza  1 , Simone D'Imporzano  1 , Yan-Bing Zhou  1 , Juan-Santiago Azagra  1 , Olivier Facy  1 , Steven T Brower  1 , Zhi-Wei Jiang  1 , Lu Zang  1 , Arda Isik  1 , Alessandro Gemini  1 , Stefano Trastulli  1 , Alexander Novotny  1 , Alessandra Marano  1 , Tong Liu  1 , Mario Annecchiarico  1 , Benedetta Badii  1 , Giacomo Arcuri  1 , Andrea Avanzolini  1 , Metin Leblebici  1 , Denis Pezet  1 , Shou-Gen Cao  1 , Martine Goergen  1 , Shu Zhang  1 , Giorgio Palazzini  1 , Vito D'Andrea  1 , Jacopo Desiderio  1
Affiliations
Comparative Study

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

Amilcare Parisi et al. World J Gastroenterol. .

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.

Keywords: Gastrectomy; Gastric cancer; Laparoscopy; Minimally invasive surgery; Robot-assisted; Robotic.

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Conflict of interest statement

Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

References

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    1. Parisi A, Nguyen NT, Reim D, Zhang S, Jiang ZW, Brower ST, Azagra JS, Facy O, Alimoglu O, Jackson PG, et al. Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits. Int J Surg. 2015;17:34–40. - PubMed
    1. Parisi A, Desiderio J. Establishing a multi-institutional registry to compare the outcomes of robotic, laparoscopic, and open surgery for gastric cancer. Surgery. 2015;157:830–831. - PubMed
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