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

摘要

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.