Surgical outcomes and learning curve analysis of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with 3D laparoscopic gastrectomy.

Abstract

162 Background: There is a lack of supporting evidence regarding the safety, efficacy and surgeon acceptance of robotic versus three-dimensional (3D) laparoscopic surgery for patients with gastric cancer (GC). Methods: An ambispective cohort study was conducted. We compared short-term surgical outcomes including financial cost between robotic and 3D laparoscopic gastrectomy for all GC patients and the GC patients treated by Prof. Chen’s team. The Cumulative Sum (CUSUM) method was developed and used to analyze the learning curves of robotic and 3D laparoscopic gastrectomy performed by Prof. Chen. Results: From August 2011 to June 2017, a total of 517 patients were enrolled for treatment with either robotic (n=408 including n=73 performed by Prof. Chen) or 3D laparoscopic (n=109 including n=71 performed by Prof. Chen) gastrectomy. There were no significant differences between the two operation methods regarding the clinical pathological characteristics, except for smoking habit (p < 0.001). In analysis of all the 517 patients, robotic group had shorter operative time (208 min vs 228 min, p=0.004), less time to first flatus (3 days vs 4 days, p=0.025), longer time to remove drainage and nasogastric tube (12 days vs 9 days, p=0.001, 6 days vs. 4 days, p=0.001, respectively), and more postoperative complications (21.3% vs. 9.2%, p=0.003). While we compared these short-term outcomes of robotic and 3D laparoscopic gastrectomy performed by Prof. Chen, only number of lymph node dissections (robotic 27 vs. 3D 33, p=0.038) and time to remove nasogastric tube (robotic 5 days vs. 3D 3 days, p < 0.001) were significantly different. CUSUM analysis showed that operative time reached a stable state after around 21 cases in robotic gastrectomy and 19 cases in 3D laparoscopic gastrectomy. The cost-effectiveness analysis showed that robotic gastrectomy had significantly higher total cost than 3D laparoscopic gastrectomy (robotic = RMB 124907 vs. 3D-laparoscopic = RMB 94395; p < 0.001). Conclusions: With comparable surgical outcomes, higher surgeon acceptance and less financial cost, 3D laparoscope is a highly recommended minimal invasive surgical method for GC patients.