Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

Abstract

Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment. However, LG suffers from technical limitations and drawbacks, such as a two-dimensional surgical field of view, limited movement of laparoscopic tools, unavoidable physiological tremors and discomfort for operating surgeon. Therefore, robotic surgery has been developed to address such limitations. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines in order to investigate the benefits and harms of robotic gastrectomy (RG) compared to the LG. PubMed/MEDLINE, Scopus, Cochrane Library (Cochrane Database of Systematic Re-views, Cochrane Central Register of Controlled Trials-CENTRAL) and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature. Results: The 7 included meta-analyses covered an approximately 20 years-study period (2000-2020). Almost all studies included in the meta-analyses were retrospective ones and originated from Asian countries (China and Korea, in particular). Examined overall population ranged from 3176 to 17,712 patients. If compared to LG, RG showed both operative advantages (operative time, estimated blood loss, number of retrieved lymph nodes) and perioperative ones (time to first flatus, time to restart oral intake, length of hospitalization, overall complications, Clavien-Dindo (CD) ≥ III complications, pancreatic complications), in the absence of clear differences of oncological outcomes. However, costs of robotic approach appear significant. Conclusions: It is impossible to make strong recommendations, due to the statistical weakness of the included studies. Further randomized, possibly multicenter trials are strongly recommended, if we want to have our results confirmed.

Keywords: gastrectomy; gastric cancer; laparoscopic; outcome; robotic; surgery.

Figure 1

PRISMA flow chart of literature search.

Figure 2

Operative time (min). RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; WMD = weighted mean difference [14,15,16,17,18,19,20].

Figure 3

Estimated blood loss (mL). RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; WMD = weighted mean difference [14,15,16,17,18,19,20].

Figure 4

Retrieved lymph nodes (n). RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; WMD = weighted mean difference [14,15,16,17,18,19,20].

Figure 5

Time to first flatus (days). RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; WMD = weighted mean difference [14,15,16,17,18,19,20].

Figure 6

Time to restart oral intake (days). RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; WMD = weighted mean difference; * liquid diet; ** solid soft diet [15,17,18,19,20].

Figure 7

Length of hospital stay (days). RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; WMD = weighted mean difference [14,15,17,18,19,20].

Figure 8

Overall complications rate. RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; OR = odds ratio (A); RR = risk ratio (B) [14,15,16,17,18,19,20].

Figure 9

CD > III complications rate. RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; OR = odds ratio (A); RR = risk ratio (B) [15,18,19,20].

Figure 10

Pancreatic complications rate. RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; OR = odds ratio [15,16,17,20].

Figure 11

Costs. RG = Robotic gastrectomy; LG = Laparoscopic gastrectomy; WMD = weighted mean difference; $ = US dollars (A); RMB = People’s Republic of China renminbi (B); OR = odds ratio (C) [15,16,19].