Comparison of open, robotic and laparoscopic gastrectomy with surgical site infection in patients with advanced gastric cancer: a retrospective cohort study

Abstract

Background: Surgical site infection (SSI) is the second most common type of nosocomial infection; approximately 500,000 SSIs occur every year in the United States. SSIs lead to increased negative patient outcomes, which contribute to the economic burden of $1–10 billion annually medical costs associated with SSI. In many studies, Laparoscopic surgery may be associated with less risk of SSI than is traditional open surgery. And Robotic surgery is an advanced minimally invasive technique than Laparoscopic surgery, which has been applied in many surgical fields. However, there were few reports about SSI after robotic surgery, especially in gastric cancer. Therefore, we investigated the comparison of robotic, laparoscopic and open gastrectomy with SSI in patients with advanced gastric cancer (AGC). Methods & Materials: A retrospective cohort study was conducted on patients with AGC undergoing robotic gastrectomy or laparoscopic gastrectomy between January 2015 and December 2015 at a 2400-bed tertiary hospital in South Korea. SSI was defined according to National Healthcare Safety Network (NHSN) criteria. Results: Total 1067 patients were included. Of them, 449 patients underwent open gastrectomy, 382 patients underwent laparoscopic gastrectomy, 236 patients underwent robotic gastrectomy. Median age was 58.4 years old, 36.6% were women. American Society of Anesthesiologists (ASA) class was lower than 3 in 76.8% of patients. The overall rate of SSI was 5.4%. The rate of SSI was not significantly different between laparoscopic and robotic gastrectomy (3.4% vs. 4.2%, p = 0.595). It may be due to these two procedure use only several incisions that the tools can be accessed. Overall mortality rate was not significantly different between two groups (0.3% vs. 0.4%, p = 0.999). On the other hand, the incidence of SSI was higher in open gastrectomy (7.8%) than other procedure. As you see the baseline charateristics, total gastrectomy was more frequently done in open gastrectomy than others. It means, the range of surgery was more broad in open gastrectomy. Conclusion: In our study, the SSI rate in patients with AGC was not significantly different for robotic gastrectomy, compared with laparoscopic gastrectomy.