Abstract
AimTo evaluate the safety and efficacy of robotic gastrectomy versus open gastrectomy for gastric cancer.MethodsA comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Knowledge was performed. Systematic review was carried out to identify studies comparing robotic gastrectomy and open gastrectomy in gastric cancer. Intraoperative and postoperative outcomes were also analyzed to evaluate the safety and efficacy of the surgery. A fixed effects model or a random effects model was utilized according to the heterogeneity.ResultsFour studies involving 5780 patients with 520 (9.00%) cases of robotic gastrectomy and 5260 (91.00%) cases of open gastrectomy were included in this meta-analysis. Compared to open gastrectomy, robotic gastrectomy has a significantly longer operation time (weighted mean differences (WMD) =92.37, 95% confidence interval (CI): 55.63 to 129.12, P<0.00001), lower blood loss (WMD: -126.08, 95% CI: -189.02 to -63.13, P<0.0001), and shorter hospital stay (WMD = -2.87; 95% CI: -4.17 to -1.56; P<0.0001). No statistical difference was noted based on the rate of overall postoperative complication, wound infection, bleeding, number of harvested lymph nodes, anastomotic leakage and postoperative mortality rate.ConclusionsThe results of this meta-analysis suggest that robotic gastrectomy is a better alternative technique to open gastrectomy for gastric cancer. However, more prospective, well-designed, multicenter, randomized controlled trials are necessary to further evaluate the safety and efficacy as well as the long-term outcome.
Highlights
Invasive surgery has become widely applied in the field of general surgery including gastric cancer [1]
The quality of the studies assessment consisted of three items: patient selection, comparability of robotic gastrectomy (RG) and open gastrectomy (OG) groups, and exposure according to a previous meta-analysis [7]
With the development of technology, robot-assisted laparoscopy has been widely performed in the field of urology [11], gynecology [12] and general surgery [13], and has become an attractive option for surgeons
Summary
Invasive surgery has become widely applied in the field of general surgery including gastric cancer [1]. Robotic systems have 3-D imaging, tremor filter, and articulated EndoWrist (Intuitive Surgical Inc., Sunnyvale, CA, USA). With these advanced equipments, robotic surgery is superior to conventional laparoscopic surgery due to its significant improvements in visibility and manipulation [3]. A variety of reports have demonstrated the safety and feasibility of this approach [5,6]. The feasibility and safety between RG and open gastrectomy (OG) in treating gastric cancer is not well elucidated. The aim of this study is to perform a systematic review and metaanalysis of studies comparing the safety and efficacy of RG versus OG in treating gastric cancer
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