Efficacy and safety of robotic vs. laparoscopic gastrectomy for patients with gastric cancer: systematic review and meta-analysis

Abstract

Background: The emergence of robotic surgical systems compensated for the technological shortcomings of laparoscopic approaches. However, whether robotic gastrectomy (RG) has better perioperative outcomes and survival than laparoscopic gastrectomy (LG) for gastric cancer (GC) is still unclear but increasingly drawing attention.

Materials and methods: In this systematic review and meta-analysis, we searched PubMed, EMBASE, Web of Science, and Cochrane Library as of 20 January 2024, and referenced a list of eligible articles for all published studies comparing RG and LG for patients with GC. Data on study characteristics, individual characteristics, and outcome parameters were extracted. The quality of studies was assessed using the Revised Cochrane risk-of-bias 2 tool and the risk of bias in nonrandomized studies of interventions tool. The main outcome measures were overall survival (OS) and disease-free survival (DFS).

Results: The authors identified 3641 articles, of which 72 studies (30 081 patients) were included in the meta-analysis. Compared with LG, RG was associated with higher OS [hazard ratio (HR)=0.89, 95% CI=0.83-0.96], lower rate of overall postoperative complications [odds ratio (OR)=0.77, 95% CI=0.71-0.84], longer operating time [mean difference (MD)=35.53, 95% CI=29.23-41.83], less estimated blood loss (MD=-37.45, 95% CI=-46.24 to -28.67), a higher number of retrieved lymph nodes (MD=1.88, 95% CI=0.77-3.00), faster postoperative recovery, and lower rate of conversion (OR=0.44, 95% CI=0.36-0.55). Mortality and DFS were not significantly different between the two groups. The subgroup of meta-analysis results also showed the advantages of robotic surgery over laparoscopic surgery in intracorporeal reconstruction, total gastrectomy, Ⅰ/Ⅱ stage, and BMI≥25, especially for patients with stage Ⅰ/Ⅱ, there are better OS and DFS.

Conclusion: Our findings point to robotic surgery having great benefits compared with laparoscopic surgery in GC. Our study may help inform decision-making in applying robotic surgical systems to clinical treatment.

Figure 1

Flowchart of the study screening and evaluation process.

Figure 2

Forest plot of the meta-analysis for overall survival and disease-free survival. (A), overall survival, (B), disease-free survival.

Figure 3

Forest plot of the meta-analysis for complications. (A) overall. complications, (B), CD≥Ⅲ complications, (C), anastomosis leakage, (D), intra-abdominal abscess/fluid collection; (E), pulmonary infection; (F), pancreatic fistula; (G), intra-abdominal bleeding.

Figure 4

Forest plot of the meta-analysis for surgical outcomes. (A), operating time, (B), estimated blood loss, (C), number of retrieved lymph nodes, (D), conversion; (E) mortality.

Figure 5

Forest plot of the meta-analysis for postoperative outcomes. (A), postoperative hospitalization stay, (B), time to first flatus, (C), time to first liquid or oral diet.

Figure 6

Forest plot of the meta-analysis for total cost.