Abstract
Background
Oncological benefits of robotic gastrectomy (RG) remain unclear. We aimed to determine and compare the 3-year outcomes of RG and laparoscopic gastrectomy (LG) for the treatment of gastric cancer.
Methods
This was a multi-institutional retrospective study of patients who prospectively underwent RG in a previous study (UMIN000015388) and historical controls who underwent LG. Operable patients with cStage I/II primary gastric cancer were enrolled. The inverse probability of treatment weighting method based on propensity scores was used to balance patient demographic factors and surgeon volume between the RG and LG groups. The primary outcome measure was the 3-year overall survival rate (3yOS).
Results
Of the 1,127 patients in the previous study, 326 and 752 patients in the RG and LG groups, respectively, completed the study. The standardized difference of all confounding factors was reduced to 0.09 or less after weighting. In the weighted population, 3yOS was 96.3% and 89.6% in the RG and LG groups, respectively (hazard ratio [HR] 0.34 [0.15, 0.76]; p = 0.009), whereas there was no difference in 3-year recurrence-free survival rate (3yRFS) between the two groups (HR 0.58 [0.32, 1.05]; p = 0.073). Sub-analyses showed that RG improved 3yOS (HR 0.05 [0.01, 0.38]; p = 0.004) and 3yRFS (HR 0.05 [0.01, 0.34]; p = 0.003) in patients with pStage IA disease. Recurrence rates and patterns were similar between the RG and LG groups. RG did not improve the morbidity rate, however, it attenuated some of the adverse events, including anastomotic leakage and intra-abdominal abscess. RG improved estimated blood loss and duration of postoperative hospitalization.
Conclusion
This study showed surgical and oncological safety of RG for cStage I/II gastric cancer considering the 3-year outcomes, compared with those of LG.
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Abbreviations
- RG:
-
Robotic gastrectomy
- LG:
-
Laparoscopic gastrectomy
- 3yOS:
-
3-Year overall survival rate
- 3yRFS:
-
3-Year recurrence-free survival rate
- HR:
-
Hazard ratio
- ASA-PS:
-
American Society of Anesthesiologists physical status
- OR:
-
Odds ratio
- CI:
-
Confidence interval
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Acknowledgements
We thank all the surgeons that participated in this study, especially Takahiro Kinoshita (National Cancer Center Hospital, East, Kashiwa, Japan), Shuji Takiguchi (Nagoya City University, Nagoya, Japan), Kazuhisa Ehara (Saitama Cancer Center, Saitama, Japan), Shiro Kuwabara (Niigata City General Hospital, Niigata, Japan), Hiroshi Okabe (New Tokyo Hospital, Matsudo, Chiba), Yoshihiro Hiramatsu (Hamamatsu University, Hamamatsu, Japan), Takeshi Omori (Osaka International Cancer Institute, Osaka, Japan), Yuji Watanabe (Ehime University, Toon, Japan), Hironori Odaira (International University of Health and Welfare, Narita, Japan), Tomohisa Egawa (Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan), and Yoshiharu Sakai (Kyoto University, Kyoto, Japan). We also thank Takaaki Kato, Takenao Koseki, and Hiroyuki Hiramatsu, who work in the data collection center (Center for Clinical Trial and Research Support, Fujita Health University). We thank Ms. Chie Yamamoto and Mr. Taiki Imaizumi of EP‐CRSU Co., Ltd. (Tokyo, Japan) for their dedicated administrative support. The authors are indebted to Editage (Tokyo, Japan, https://www.editage.jp/info/) for language review of this paper.
Funding
Administrative support for this study, provided by EP-CRSU Co., Ltd, was funded by Intuitive Surgical Sarl. The funder was not involved in the study design; the collection, analysis, and interpretation of data; the writing of this article; or the decision to submit the article for publication.
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All the authors fully met the International Committee of Medical Journal Authors authorship criteria. All the authors read and approved the final manuscript. All authors are accountable for all aspects of this study and are responsible for ensuring that questions related to the accuracy or integrity of any part of the study are appropriately investigated and resolved.
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Koichi Suda was funded by Sysmex, Co. in relation to the Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University. Koichi Suda also received advisory fees from Medicaroid, Inc., outside of the present study. Tsuyoshi Tanaka and Ichiro Uyama were funded by Medicaroid, Inc. in relation to the Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University. Ichiro Uyama received lecture fees from Intuitive Surgical, Inc., outside of the present study. Kazutaka Obama received lecture fees from Intuitive Surgical, Inc., Medtronic, Ethicon, Medicaroid, Inc., and Olympus, outside of the present study. Ataru Igarashi received research expenses from Intuitive Surgical, Inc., outside of the present study. Masanori Terashima received personal fees from Taiho Pharmaceutical, Chugai Pharmaceutical, Ono Pharmaceutical, BMS, Yakult Honsha, Takeda Pharmaceutical, Eli Lilly Japan, Pfizer Japan, Daiichi-Sankyo, Johnson and Johnson, Medtronic Japan, Intuitive Surgical Japan, and Olympus, outside the submitted work. Miyoshi Sakai, Yukie Yoda, Susumu Shibasaki, Masaya Nakauchi, Shigeo Hisamori, Tatsuto Nishigori, and Hirokazu Noshiro have no conflicts of interest or financial ties to disclose. Koichi Suda, Kazutaka Obama, Tsuyoshi Tanaka, Ataru Igarashi, Masanori Terashima, and Ichiro Uyama have no conflicts of interest or financial ties to disclose in relation to the present study.
Ethical approval
The protocol for this research project has been approved by a suitably constituted Ethics Committee (Institutional Review Board of Fujita Health University, Approval No. HM18-281), and it conforms to the provisions of the Declaration of Helsinki. The opt-out method was used to obtain informed consent from all participating patients. This study was registered in the University Hospital Medical Information Network (UMIN000034366) before the start of the study.
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Suda, K., Sakai, M., Obama, K. et al. Three-year outcomes of robotic gastrectomy versus laparoscopic gastrectomy for the treatment of clinical stage I/II gastric cancer: a multi-institutional retrospective comparative study. Surg Endosc 37, 2858–2872 (2023). https://doi.org/10.1007/s00464-022-09802-w
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DOI: https://doi.org/10.1007/s00464-022-09802-w