Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep;27(5):932-946.
doi: 10.1007/s10120-024-01534-1. Epub 2024 Jul 11.

A systematic review on the effectiveness of robot-assisted minimally invasive gastrectomy

L Triemstra  1 , R B den Boer  1 , M M Rovers  2 , C E V B Hazenberg  3 , R van Hillegersberg  1 , J P C Grutters  4 , J P Ruurda  5
Affiliations

A systematic review on the effectiveness of robot-assisted minimally invasive gastrectomy

L Triemstra et al. Gastric Cancer. 2024 Sep.

Abstract

Background: Robot-assisted minimally invasive gastrectomy (RAMIG) is increasingly used as a surgical approach for gastric cancer. This study assessed the effectiveness of RAMIG and studied which stages of the IDEAL-framework (1 = Idea, 2A = Development, 2B = Exploration, 3 = Assessment, 4 = Long-term follow-up) were followed.

Methods: The Cochrane Library, Embase, Pubmed, and Web of Science were searched for studies on RAMIG up to January 2023. Data collection included the IDEAL-stage, demographics, number of participants, and study design. For randomized controlled trials (RCTs) and long-term studies, data on intra-, postoperative, and oncologic outcomes, survival, and costs of RAMIG were collected and summarized.

Results: Of the 114 included studies, none reported the IDEAL-stage. After full-text reading, 18 (16%) studies were considered IDEAL-2A, 75 (66%) IDEAL-2B, 4 (4%) IDEAL-3, and 17 (15%) IDEAL-4. The IDEAL-stages were followed sequentially (2A-4), with IDEAL-2A studies still ongoing. IDEAL-3 RCTs showed lower overall complications (8.5-9.2% RAMIG versus 17.6-19.3% laparoscopic total/subtotal gastrectomy), equal 30-day mortality (0%), and equal length of hospital stay for RAMIG (mean 5.7-8.5 days RAMIG versus 6.4-8.2 days open/laparoscopic total/subtotal gastrectomy). Lymph node yield was similar across techniques, but RAMIG incurred significantly higher costs than laparoscopic total/subtotal gastrectomy ($13,423-15,262 versus $10,165-10,945). IDEAL-4 studies showed similar or improved overall/disease-free survival for RAMIG.

Conclusion: During worldwide RAMIG implementation, the IDEAL-framework was followed in sequential order. IDEAL-3 and 4 long-term studies showed that RAMIG is similar or even better to conventional surgery in terms of hospital stay, lymph node yield, and overall/disease-free survival. In addition, RAMIG showed reduced postoperative complication rates, despite higher costs.

Keywords: Gastric Cancer; IDEAL-framework; Implementation; RAMIG; Robot-assisted gastrectomy.

PubMed Disclaimer

Conflict of interest statement

Jelle P. Ruurda: Consulting or Advisory Role: Intuitive Surgical, Medtronic. Richard van Hillegersberg: Consulting or Advisory Role: Intuitive Surgical, Medtronic. All other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA Flowchart
Fig. 2
Fig. 2
Distribution of published RAMIG studies according to IDEAL-2A, 2B, 3 and 4 stages. Upper = World, lower = Europe
Fig. 3
Fig. 3
Course of IDEAL-stages 2A, 2B, 3, and 4 of included studies over time Worldwide (upper graph) and in Europe (lower graph)
Fig. 4
Fig. 4
Summary of the risk of bias for randomized controlled/clinical studies [–24]
Fig. 5
Fig. 5
Summary of the risk of bias for non-randomized clinical trials [–44]
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. 10.3322/caac.21660 - DOI - PubMed
    1. Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. The Lancet. 2019;393(10184):1948–57.10.1016/S0140-6736(18)32557-1 - DOI - PubMed
    1. Cunningham D, Allum WH, Stenning SP. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006. 10.1056/NEJMoa055531. 10.1056/NEJMoa055531 - DOI - PubMed
    1. Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008;358(1):36–46. 10.1056/NEJMoa073149 - DOI - PubMed
    1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted billroth I gastrectomy. Surg Laparosc Endosc. 1994;4(2):146–8. - PubMed

Publication types

MeSH terms

LinkOut - more resources