Robotic vs. laparoscopic gastrectomy for patients with locally advanced gastric cancer: a meta-analysis of randomized controlled trials and propensity-score-matched studies

摘要

BACKGROUND: The role of robotic surgery for the treatment of locally advanced gastric cancer remains controversial. This meta-analysis aimed to compare the short-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for patients with locally advanced gastric cancer using data collected from randomized controlled trials (RCTs) and propensity score-matched (PSM) studies. MATERIALS AND METHODS: We searched PubMed, Cochrane Library, EMBASE, and Web of Science databases for RCTs and PSM studies comparing RG and LG. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. RESULTS: Fifteen studies encompassing one RCT and 14 PSM studies were included, with a total of 5079 patients (RG group: 2279 patients; LG group: 2800 patients). Although RG was associated with a longer operative time (MD, 19.82 min), patients may benefit from reduced blood loss (MD, -28.91 mL), shorter length of stay (MD, -0.69 days), lower morbidity (RR, 0.82), major complications (RR, 0.71), blood transfusion rate (RR, 0.60), conversion rate (RR, 0.38), and higher number of harvested lymph nodes (MD, 3.25). There were no significant differences observed in readmission (RR, 0.89), mortality (RR, 0.75), reoperation (RR, 0.71), and R0 resection (RR, 0.99) between the groups. In addition, RG shortened the time to first flatus (MD, -0.38 days), the time to first liquid intake (MD, -0.31 days), and the time to first soft diet intake (MD, -0.20 days). CONCLUSIONS: RG seems associated with improved short-term outcomes and enhanced postoperative recovery in locally advanced gastric cancer compared to LG. In the future, RG may become a safe and effective alternative to LG. Further research is needed to investigate long-term outcomes and confirm the promising advantages of RG in locally advanced gastric cancer.