Comparative outcomes of laparoscopic and robotic approaches to gastrectomy: a National Cancer Database study.

Abstract

Gastric cancer is associated with significant mortality worldwide. Radical gastrectomy with lymphadenectomy is considered the only curative option. Traditionally, these operations are associated with significant morbidity. Laparoscopic gastrectomy (LG) and more recently robotic gastrectomy (RG) techniques have been developed to potentially decrease the perioperative morbidity. We sought to compare oncologic outcomes with laparoscopic and robotic techniques for gastrectomy. Utilizing the National Cancer Database we identified patients who underwent gastrectomy for adenocarcinoma. Patients were stratified by open, robotic or laparoscopic surgical technique. Open gastrectomy patients were excluded. We identified 1,301 patients who underwent RG and 4,892 LG with median ages of 65 (20-90) and 66 (18-90) respectively, p = 0.02. The mean number of positive lymph nodes were higher in the LG 2.2 ± 4.4 vs RG 1.9 ± 3.8, p = 0.01. The R0 resections were higher in the RG at 94.5% vs 91.9% in LG, p = 0.001. Conversions to open were 7.1% in the RG and 16% in the LG group, p < 0.001. The median length of hospitalization was 8 (6-11) in both groups. There was no difference in the 30-day readmission (p = 0.65), 30-day mortality (p = 0.85) and 90-day mortality (p = 0.34) between groups. The median and overall 5-year survival was 71.3 mo and 56% in the RG and 66.1 mo and 52% in the LG, p = 0.03. Multivariate analysis revealed that age, Charlson-Deyo comorbidity scores, location of gastric cancer, histology grade, pathologic T-stage, pathologic N-stage, surgical margins, and facility volume were all predictors of survival. Robotic and laparoscopic techniques are both acceptable approaches to gastrectomy. However, conversions to open are higher and R0 resections rates are lower in the laparoscopic group. Additionally, a survival benefit is demonstrated in those undergoing robotic gastrectomy.