OGC P66 A systematic review of robot-assisted minimally invasive gastrectomy to examine current global evidence and reporting standards according to IDEAL-stages

Abstract

Abstract Background Despite increasing use for gastric cancer surgery, it is unclear how robot-assisted minimally invasive gastrectomy (RAMIG) has been evaluated. This study assessed how RAMIG was evaluated using the IDEAL-framework (1=Idea, 2A=Development, 2B=Exploration, 3=Assessment, 4=Long-term follow-up) during its implementation and reviewed its current evidence. Methods The Cochrane Library, Embase, Pubmed, and Web of Science were searched for studies on RAMIG up to January 2023. Data collection included IDEAL-stage, demographics, number of participants, and study design. For RCTs and long-term studies data on postoperative, clinical, and oncologic outcomes, survival, and costs of RAMIG were collected and summarized. Results Full-text screening revealed 114 of 2338 included studies. Of these studies, 18 (16%) were considered IDEAL-2A, 75 (66%) IDEAL-2B, 4 (3%) IDEAL-3, and 17 (17%) IDEAL-4, although none described their IDEAL-stages (Figure 1). IDEAL-3 RCTs showed lower overall complications after RAMIG (8.5-9.2% RAMIG versus 17.6-19.3% laparoscopic gastrectomy, p=<0.05), low 30-day mortality (0-3%) and shorter or equal length of hospital stay for RAMIG (mean 5.7-8.5 days RAMIG versus 6.4-8.2 days open/laparoscopic gastrectomy, p<0.05/p=0.854). Lymph node yield was similar for all techniques. The costs of RAMIG were significantly higher than laparoscopic gastrectomy ($13,423-15,262 versus $10,165-10,945, p<0.001). IDEAL-4 studies showed similar or improved 1-, 3- and 5-year overall/disease-free survival for RAMIG. Conclusions During the implementation of RAMIG, the IDEAL-framework was followed across the world in sequential order. IDEAL-3 and 4 long-term study results showed that RAMIG is non-inferior to conventional surgery in terms of overall complications, length of hospital stay, lymph node yield, and overall and disease-free survival.