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Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short- and long-term results

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Abstract

Background

Emerging evidence has demonstrated that either laparoscopic-assisted gastrectomy (LAG) or robotic-assisted gastrectomy (RAG) could be adopted as standard treatment for early gastric cancer. However, the long-term survival and recurrence rate after LAG or RAG for locally advanced gastric cancer (AGC) has seldom been reported.

Methods

We retrospectively analyzed the data from 339 patients who underwent LAG and 163 patients who underwent RAG from a prospectively established database in the Chinese People’s Liberation Army General Hospital. We compared the short- and long-term oncological outcomes of the RAG group versus the LAG group in the entire cohort, and in a propensity score-matched cohort.

Results

Before propensity score matching (PSM), the two groups revealed comparable 3-year overall survival rates (OS, RAG vs. LAG: 76.1 vs. 81.7%, p = 0.118), and recurrence-free survival rates (RFS, RAG vs. LAG: 73.0 vs. 67.6%, p = 0.297). Similar results were obtained in the propensity score-matched cohort; the respective overall survival rates in the propensity score-matched RAG and LAG groups were 76.1 and 79.8% (p = 0.552), and the respective RFS rates were 73.0 and 68.7% (p = 0.386). After PSM, RAG was still associated with a significantly longer mean operating time (249.46 ± 63.26 vs. 232.17 ± 65.39 min, p = 0.008) and higher total costs (133.38 ± 41.62 vs. 95.34 ± 29.39 103 RMB, p < 0.001) than LAG; the two groups did not significantly differ in other surgical and oncological characteristics.

Conclusion

Although there were some differences in the outcomes of RAG versus LAG in AGC patients, both RAG and LAG were similar in short-term recovery and long-term oncological outcomes.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386

    Article  CAS  PubMed  Google Scholar 

  2. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Article  Google Scholar 

  3. Son T, Hyung WJ (2016) Laparoscopic gastric cancer surgery: current evidence and future perspectives. World J Gastroenterol 22:727–735

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lee J, Kim YM, Woo Y, Obama K, Noh SH, Hyung WJ (2015) Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc 29:3251–3260

    Article  PubMed  Google Scholar 

  5. Shen W, Xi H, Wei B, Cui J, Bian S, Zhang K, Wang N, Huang X, Chen L (2016) Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes. Surg Endosc 30:574–580

    Article  PubMed  Google Scholar 

  6. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 249:927–932

    Article  PubMed  Google Scholar 

  7. An JY, Kim SM, Ahn S, Choi MG, Lee JH, Sohn TS, Bae JM, Kim S (2018) Successful robotic gastrectomy does not require extensive laparoscopic experience. J Gastric Cancer 18:90–98

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yang SY, Roh KH, Kim YN, Cho M, Lim SH, Son T, Hyung WJ, Kim HI (2017) Surgical outcomes after open, laparoscopic, and robotic gastrectomy for gastric cancer. Ann Surg Oncol 24:1770–1777

    Article  PubMed  Google Scholar 

  9. Hyun MH, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH, Kim JH, Park SH, Mok YJ, Park SS (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20:1258–1265

    Article  PubMed  Google Scholar 

  10. Shi Y, Xu X, Zhao Y, Qian F, Tang B, Hao Y, Luo H, Chen J, Yu P (2018) Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 32:2427–2433

    Article  PubMed  Google Scholar 

  11. Hu Y, Ying M, Huang C, Wei H, Jiang Z, Peng X, Hu J, Du X, Wang B, Lin F, Xu J, Dong G, Mou T, Li G (2014) Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 28:2048–2056

    Article  PubMed  Google Scholar 

  12. Zhou J, Shi Y, Qian F, Tang B, Hao Y, Zhao Y, Yu P (2015) Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol 111:760–767

    Article  PubMed  Google Scholar 

  13. Li J, Xi H, Cui J, Zhang K, Gao Y, Liang W, Cai A, Wei B, Chen L (2018) Minimally invasive surgery as a treatment option for gastric cancer with liver metastasis: a comparison with open surgery. Surg Endosc 32:1422–1433

    Article  PubMed  Google Scholar 

  14. Fiegel H, Gfroerer S, Rolle U (2016) Systematic review shows that pathological lead points are important and frequent in intussusception and are not limited to infants. Acta Paediatr 105:1275–1279

    Article  PubMed  Google Scholar 

  15. Nifong LW, Chitwood WR, Pappas PS, Smith CR, Argenziano M, Starnes VA, Shah PM (2005) Robotic mitral valve surgery: a United States multicenter trial. J Thorac Cardiovasc Surg 129:1395–1404

    Article  PubMed  Google Scholar 

  16. Pan HF, Wang G, Liu J, Liu XX, Zhao K, Tang XF, Jiang ZW (2017) Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 27:428–433

    Article  PubMed  Google Scholar 

  17. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH (2013) Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01). J Korean Surg Soc 84:123–130

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357

    Article  PubMed  Google Scholar 

  19. Zhang CD, Chen SC, Feng ZF, Zhao ZM, Wang JN, Dai DQ (2013) Laparoscopic versus open gastrectomy for early gastric cancer in Asia: a meta-analysis. Surg Laparosc Endosc Percutan Tech 23:365–377

    Article  PubMed  Google Scholar 

  20. Procopiuc L, Tudor S, Manuc M, Diculescu M, Vasilescu C (2016) Open vs robotic radical gastrectomy for locally advanced gastric cancer. Int J Med Robot 12:502–508

    Article  PubMed  Google Scholar 

  21. Smith DD, Schwarz RR, Schwarz RE (2005) Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 23:7114–7124

    Article  PubMed  Google Scholar 

  22. Jiao XG, Deng JY, Zhang RP, Wu LL, Wang L, Liu HG, Hao XS, Liang H (2014) Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol 20:3640–3648

    Article  PubMed  PubMed Central  Google Scholar 

  23. Park SS, Kim MC, Park MS, Hyung WJ (2012) Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc 26:60–67

    Article  PubMed  Google Scholar 

  24. Obama K, Kim YM, Kang DR, Son T, Kim HI, Noh SH, Hyung WJ (2018) Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer 21:285–295

    Article  PubMed  Google Scholar 

  25. Liu G, Jian F, Wang X, Chen L (2016) Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial. Onco Targets Ther 9:3345–3351

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was funded by the National Nature Science Foundation of China (Nos. 81672319, 81602507, and 81773135), the National Key Research and Development Plan (Nos. 2016YFC0905302 and 2017YFC0908305), the Beijing Municipal Science and Technology Plan Projects (Nos. Z161100000516237 and D141100000414002), the Beijing Municipal Citizen Health Project (Z151100003915147, Z171100000417023), Beijing Nova Program (No. Z181100006218011), and the Chinese PLA General Hospital Big Data R&D Project (2016MBD-012).

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Author notes

  1. Yunhe Gao, Hongqing Xi and Zhi Qiao have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Chinese People’s Liberation Army General Hospital, Fuxing Road 28, Beijing, 100853, People’s Republic of China

    Yunhe Gao, Hongqing Xi, Zhi Qiao, Jiyang Li, Kecheng Zhang, Tianyu Xie, Jianxin Cui, Bo Wei & Lin Chen

  2. General Surgery Institute, Chinese People’s Liberation Army General Hospital, Fuxing Road 28, Beijing, 100853, People’s Republic of China

    Yunhe Gao, Hongqing Xi, Jiyang Li, Kecheng Zhang, Bo Wei & Lin Chen

  3. Nanjing General Hospital of Nanjing Military Command, Nanjing, 210002, People’s Republic of China

    Weisong Shen

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  1. Yunhe Gao
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Correspondence to Bo Wei or Lin Chen.

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Dr. Yunhe Gao, Hongqing Xi, Jiyang Li, Kecheng Zhang, Tianyu Xie, Weisong Shen, Jianxin Cui, and Prof. Zhi Qiao, Bo Wei, Lin Chen have no conflicts of interest or financial ties to disclose.

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Gao, Y., Xi, H., Qiao, Z. et al. Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short- and long-term results. Surg Endosc 33, 528–534 (2019). https://doi.org/10.1007/s00464-018-6327-5

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  • DOI: https://doi.org/10.1007/s00464-018-6327-5

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