Robotic gastrectomy for gastric cancer: Current status and short-term clinical outcome in our hospital

161 Background: As robotic surgery techniques advances, robotic gastrectomy has emerged as an alternative modality for advanced gastric cancer (AGC). However, there is a lack of supporting evidence regarding the safety, effectiveness and surgeon acceptance of robotic gastrectomy for AGC patients. Methods: An ambispective cohort study was conducted. We compared surgical and oncological outcomes between robotic and traditional laparoscopic gastrectomy for AGC patients. The Cumulative Sum (CUSUM) method was developed and used to analyze the learning curves of robotic gastrectomy for AGC by two surgeons who had different surgical experience. Results: From August 2011 to June 2017, a total of 134 AGC patients were performed robotic gastrectomy by surgeon A (n = 42) and surgeon B (n = 147). And there were 238 AGC patients received traditional laparoscopic gastrectomy which performed by the same two surgeons over the same period. There were no significant differences between the two operation methods regarding the clinicopathologic characteristics and long-term outcomes (p=0.737). However, robotic gastrectomy group had less operative blood loss (229 ml vs. 240 ml, p=0.031) and less Clavien-Dindo Grade II to IV complications (p=0.006) than laparoscopic group. Clinicopathologic characteristics, short-term and long-term outcomes of the patients treated by surgeon A and surgeon B are similarity. CUSUM analysis showed that operative time reached a stable state after around 12 cases in surgeon A who had more open gastrectomy experience than laparoscopic gastrectomy experience, and 21 cases in surgeon B who had more laparoscopic gastrectomy experience than open gastrectomy experience. The stable operation time was 242 min for surgeon A and 236 min for surgeon B. The number of lymph node dissections was 38 for surgeon A and 28 for surgeon B during their capacity-increasing phase. Conclusions: Robotic gastrectomy achieved superior short-term outcomes and comparable long-term outcomes compared with traditional laparoscopic gastrectomy for AGC patients. Surgeons with sufficient experience in either open or laparoscopic gastrectomy can rapidly overcome the learning curve and performed gastrectomy for AGC patients safely.

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MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600020013 ◽

2016 ◽

Vol 29 (2) ◽

pp. 117-120 ◽

Cited By ~ 10

Author(s):

Leandro Cardoso BARCHI ◽

Carlos Eduardos JACOB ◽

Cláudio José Caldas BRESCIANI ◽

Osmar Kenji YAGI ◽

Donato Roberto MUCERINO ◽

...

Keyword(s):

Gastric Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Large Scale ◽

Laparoscopic Approach ◽

Current Status ◽

Cochrane Library ◽

Robotic Gastrectomy ◽

Conventional Surgery

ABSTRACT Introduction: Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. Objective: To evaluate and summarize the current status of minimally invasive resection of gastric cancer. Methods: A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. Results: 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Conclusion: Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale.

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Current status of robotic gastrectomy for gastric cancer

Surgery Today ◽

10.1007/s00595-015-1190-7 ◽

2015 ◽

Vol 46 (5) ◽

pp. 528-534 ◽

Cited By ~ 21

Author(s):

Kazutaka Obama ◽

Yoshiharu Sakai

Keyword(s):

Gastric Cancer ◽

Current Status ◽

Robotic Gastrectomy

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Current status of robotic gastrectomy for gastric cancer: comparison with laparoscopic gastrectomy

Updates in Surgery ◽

10.1007/s13304-020-00958-5 ◽

2021 ◽

Author(s):

Yoo Min Kim ◽

Woo Jin Hyung

Keyword(s):

Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Current Status ◽

Robotic Gastrectomy

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Surgical outcomes and learning curve analysis of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with 3D laparoscopic gastrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.162 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 162-162

Author(s):

Lin Chen ◽

Jiyang Li ◽

Xin Guo ◽

Hongqing Xi ◽

Yunhe Gao ◽

...

Keyword(s):

Gastric Cancer ◽

Nasogastric Tube ◽

Laparoscopic Gastrectomy ◽

Surgical Outcomes ◽

Operative Time ◽

Multidimensional Analysis ◽

Robotic Gastrectomy ◽

Short Term ◽

Financial Cost ◽

3D Laparoscopic Gastrectomy

162 Background: There is a lack of supporting evidence regarding the safety, efficacy and surgeon acceptance of robotic versus three-dimensional (3D) laparoscopic surgery for patients with gastric cancer (GC). Methods: An ambispective cohort study was conducted. We compared short-term surgical outcomes including financial cost between robotic and 3D laparoscopic gastrectomy for all GC patients and the GC patients treated by Prof. Chen’s team. The Cumulative Sum (CUSUM) method was developed and used to analyze the learning curves of robotic and 3D laparoscopic gastrectomy performed by Prof. Chen. Results: From August 2011 to June 2017, a total of 517 patients were enrolled for treatment with either robotic (n=408 including n=73 performed by Prof. Chen) or 3D laparoscopic (n=109 including n=71 performed by Prof. Chen) gastrectomy. There were no significant differences between the two operation methods regarding the clinical pathological characteristics, except for smoking habit (p < 0.001). In analysis of all the 517 patients, robotic group had shorter operative time (208 min vs 228 min, p=0.004), less time to first flatus (3 days vs 4 days, p=0.025), longer time to remove drainage and nasogastric tube (12 days vs 9 days, p=0.001, 6 days vs. 4 days, p=0.001, respectively), and more postoperative complications (21.3% vs. 9.2%, p=0.003). While we compared these short-term outcomes of robotic and 3D laparoscopic gastrectomy performed by Prof. Chen, only number of lymph node dissections (robotic 27 vs. 3D 33, p=0.038) and time to remove nasogastric tube (robotic 5 days vs. 3D 3 days, p < 0.001) were significantly different. CUSUM analysis showed that operative time reached a stable state after around 21 cases in robotic gastrectomy and 19 cases in 3D laparoscopic gastrectomy. The cost-effectiveness analysis showed that robotic gastrectomy had significantly higher total cost than 3D laparoscopic gastrectomy (robotic = RMB 124907 vs. 3D-laparoscopic = RMB 94395; p < 0.001). Conclusions: With comparable surgical outcomes, higher surgeon acceptance and less financial cost, 3D laparoscope is a highly recommended minimal invasive surgical method for GC patients.

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