Robotic Gastrectomy as an Oncologically Sound Alternative to Laparoscopic Resections for the Treatment of Early-Stage Gastric Cancers | Gastroenterology | JAMA Surgery | JAMA Network
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Original Article
Sep 2011

Robotic Gastrectomy as an Oncologically Sound Alternative to Laparoscopic Resections for the Treatment of Early-Stage Gastric Cancers

Author Affiliations

Author Affiliations: Department of Surgery (Drs Woo, Hyung, Pak, Inaba, Obama, Choi, and Noh), Robot and Minimally Invasive Surgery Center (Drs Woo and Hyung), and Brain Korea 21 Project for Medical Science (Drs Hyung and Noh), Yonsei University College of Medicine, Seoul; and Department of Surgery, Fujita Health University School of Medicine, Aichi (Dr Inaba), and Department of Gastroenterological Surgery, Kyoto University, Kyoto (Dr Obama), Japan.

Arch Surg. 2011;146(9):1086-1092. doi:10.1001/archsurg.2011.114

Objective To evaluate the comparative safety and efficacy of robotic vs laparoscopic gastrectomy for early-stage gastric cancer.

Design Retrospective analysis.

Setting Tertiary hospital.

Patients Eight hundred twenty-seven patients with gastric cancer.

Interventions Between July 2005 and April 2009, 827 patients with gastric cancer underwent 236 robotic and 591 laparoscopic radical gastrectomies with curative intent. The patients' data were prospectively collected and retrospectively analyzed.

Main Outcome Measures We performed a comparative analysis between the robotic surgery group and laparoscopic surgery group for preoperative patient characteristics, intraoperative factors, and postoperative morbidity and mortality.

Results The robotic group was younger than the laparoscopic group, but other preoperative patient characteristics did not differ. The mean operative time for the robotic group (219.5 minutes) was on average 49 minutes longer than the laparoscopic group (170.7 minutes) (P < .001), while mean blood loss was significantly less in the robotic group (91.6 mL vs 147.9 mL; P = .002). The robotic group had mortality of 0.4% and morbidity of 11.0%, comparable with those of the laparoscopic group (P > .05). The number of lymph nodes retrieved per level was adequate in both groups and did not differ significantly. Robotic D1+α (n = 5), D1+β (n = 126), and D2 (n = 105) dissections retrieved 27.2, 36.7, and 42.4 mean numbers of lymph nodes, respectively. Except for 3 cases in the laparoscopic group, all specimens had negative margins.

Conclusions Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy. A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery.