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

• Published in: Surgical endoscopy Vol. 33; no. 2; pp. 528 - 534
• Main Authors: Gao, Yunhe, Xi, Hongqing, Qiao, Zhi, Li, Jiyang, Zhang, Kecheng, Xie, Tianyu, Shen, Weisong, Cui, Jianxin, Wei, Bo, Chen, Lin
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2019; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Body Mass Index; Female; Follow-Up Studies; Gastrectomy - methods; Gastric cancer; Gastroenterology; Gynecology; Hepatology; Humans; Kaplan-Meier Estimate; Laparoscopy; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Operative Time; Proctology; Propensity Score; Retrospective Studies; Robotic Surgical Procedures; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Survival Rate; Treatment Outcome; Gastric cancer; Laparoscopic-assisted gastrectomy; Robotic-assisted gastrectomy; Clinical outcomes
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-018-6327-5

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 10
3
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.