Robot-assisted gastrectomy for cancer

Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer

BACKGROUND

Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical practice is still uncertain. We aimed to critically review the relevant evidence comparing robotic to standard laparoscopic surgery in performing radical gastrectomy.

METHODS

The Pubmed/Medline electronic databases were searched through February 2021. Paper conference and the English language was the only restriction applied to our search strategy.

RESULTS

According to the existing data, robotic gastrectomy seems to provide some benefits in terms of blood loss, rate of conversion, procedure-specific postoperative morbidity, and length of hospital stay. Robotic gastrectomy is also associated with a longer duration of surgery and a higher economic burden as compared to its laparoscopic counterpart. No significant differences have been disclosed in terms of long-term survivals, while the number of lymph nodes retrieved with robotic gastrectomy is generally higher than that of laparoscopy.

CONCLUSIONS

The current literature suggests that robotic radical gastrectomy appears as competent as the conventional laparoscopic procedure and may provide some clinical advantages. However, due to the relative paucity of high-level evidence, it is not possible to draw definitive conclusions.

Pooled analysis of the oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer

Aim:

Robotic gastrectomy (RG) is more and more widely used in the treatment of gastric cancer. However, the long-term oncological outcomes of RG have not been well evaluated. The aim of this study was to evaluate the long-term oncological outcomes of RG and laparoscopic gastrectomy (LG) in the treatment of gastric cancer.

Materials and Methods:

PubMed, China National Knowledge Infrastructure, Cochrane Library and EMBASE electronic databases were searched until August 2019. Eligible studies were analysed for comparison of oncological outcomes between RG and LG in patients with gastric cancer.

Results:

Eleven retrospective comparative studies, which included 1347 (32.52%) patients in the RG group and 2795 (67.48%) patients in the LG group, were selected for the analysis. Meta-analysis of the 11 included studies showed that there was no statistically significant difference in the OS between the RG and LG groups (hazard ratios [HRs] = 0.97, 95% confidence intervals [CIs] = 0.80–1.19, P = 0.80). Six studies evaluated disease-free survival (DFS), and pooled analysis showed that there was no statistically significant difference in DFS between RG group and LG group (HR = 0.94, 95% CIs = 0.72–1.23, P = 0.65). According to the odds ratio (OR) analysis, there was no significant difference in 3-year OS, 5-year OS, 3-year DFS and 5-year DFS between the RG and LG groups. Nine articles reported the recurrence rate, and the meta-analysis showed that there was no statistically significant difference between the RG and LG groups (OR = 0.88, 95% CIs = 0.69–1.12, P = 0.31).

Conclusions:

This meta-analysis indicated that the long-term oncological outcomes in the RG group were similar to that in the LG group.

Totally Robotic Distal Gastrectomy: A Safe and Feasible Minimally Invasive Technique for Gastric Cancer Patients Who Undergo Distal Gastrectomy

PURPOSES

To explore the safety and feasibility of totally robotic distal gastrectomy (TRDG) for gastric cancer patients who undergo distal gastrectomy.

METHODS

Consecutive patients with gastric cancer who underwent TRDG (TRDG group) and robotic-assisted distal gastrectomy (RADG) (RADG group) were systematically reviewed at the Second Xiangya Hospital of Central South University from October 2015 to August 2018. Data were collected and statistically analyzed.

RESULTS

A total of 161 consecutive patients were included in this study: 84 cases in the TRDG group and 77 in the RADG group. Clinical characteristics and pathological results were mostly similar in both groups. The TRDG group had a significantly longer anastomotic time (20.6 ± 3.3 vs. 17.5 ± 4.0 min, p ˂ 0.001) but showed no difference in total operating time (167.0 ± 18.0 vs. 162.9 ± 17.6 min, p = 0.159). The postoperative hospitalization in the TRDG group was shorter than that in the RADG group (6.7 ± 1.2 vs. 7.2 ± 1.7 days, p = 0.019). Conversion rate, estimated blood loss, and postoperative complications were similar in both groups. There were no statistical differences in the estimated 2-year disease-free survival and overall survival rate between both groups.

CONCLUSIONS

Although our current results need to be verified in further studies, TRDG represents a safe and feasible approach to distal gastrectomy and embodies the theory of minimally invasive surgery.

Feasibility of robotic resection of gastrointestinal stromal tumors along the entire gastrointestinal tract

Robotic surgery has been proposed over the last decade as a valid option to treat gastrointestinal malignancies in a minimally invasive method, yielding encouraging results. The authors examine the outcomes of a consecutive series of patients with stromal gastrointestinal neoplasms who were operated on using a totally robotic technique. There were 36 patients in the study, with median age 70 years. Resected tumors were located in the esophagus, stomach, duodenum, small intestine and rectum. Perioperative morbidity was 8% and no mortality occurred. R0 resection was achieved in all cases. At a median follow-up of 25 months, 35 patients were disease free while there was one case of death related to metastatic disease. Robotic surgery is a valid option to resect gastrointestinal stromal tumors anywhere along the gastrointestinal tract in a minimally invasive manner.

Pancreatic Complications After Conventional Laparoscopic Radical Gastrectomy Versus Robotic Radical Gastrectomy: Systematic Review and Meta-Analysis

BACKGROUND

Recent reports have suggested that the use of the robot might reduce the rate of pancreatic complications following minimally invasive radical gastrectomy.

METHODS

By meta-analyzing the available literature, we aimed to elucidate possible differences between conventional laparoscopic and robotic radical gastrectomy on pancreatic morbidity.

RESULTS

More than 2000 patients from eight studies were eventually included in the analysis. The overall incidence of postoperative pancreatic complications was 2.2%, being 1.7% and 2.5% following robotic and laparoscopic gastrectomy (LG), respectively. In particular, pancreatic fistula occurred in 2.7% of patients receiving robotic gastrectomy (RG) and 3.8% of patients receiving laparoscopy.

CONCLUSIONS

The use of the robot showed a trend toward better outcomes compared with laparoscopy, despite the presence of more advanced disease and higher body mass index. The meta-analysis resulted in an odd ratio of 0.8 favoring RG over LG on pancreatic morbidity, although without statistical significance.

Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes

BACKGROUND

Over recent decades, minimally invasive esophagectomy has gained popularity and is increasingly performed worldwide. The aim of this work was to investigate the perioperative, clinicopathologic, and oncological outcomes of robot-assisted esophagectomy on a consecutive series of totally robotic procedures.

METHODS

All patients received either an Ivor Lewis or a McKeown procedure according to tumor location. Perioperative, clinicopathologic and oncological outcomes were examined.

RESULTS

A total of 38 patients underwent robot-assisted esophagectomy procedures. All underwent surgery for primary esophageal neoplasms. Neoadjuvant therapy was given to 22 patients. R0 resections were achieved in all patients and no conversion to open surgery occurred. Overall morbidity and mortality were 42% and 10%, respectively. The 1 year disease free survival was 78.9%, whereas the 1 year overall survival was 84.2%.

CONCLUSIONS

Robotic surgery can be employed to treat esophageal malignancy competently. Robotic esophagectomy satisfies all features of pathologic appropriateness and offers the expected oncological results.

Robotic oesophago-gastric cancer surgery

A postoperative complications rate of nearly 50% has compelled oesophago-gastric practice to adopt minimally invasive techniques such as robotic surgery

Robot-assisted distal gastrectomy with lymph node dissection for gastric cancer in a patient with situs inversus partialis: a case report with video file

BACKGROUND

Situs inversus is a rare congenital condition that is currently classified into two types: complete situs inversus (situs inversus totalis, SIT) and partial situs inversus (situs inversus partialis, SIP). In SIP patients, some organs are inverted and others are in their expected position, and individual patient variation in organ position increases surgical difficulty. Several surgeons have performed laparoscopic or robotic surgeries in situs inversus patients, but almost all were SIT patients. We report the first case, to our knowledge, of an SIP patient with gastric cancer who was successfully treated by robot-assisted distal gastrectomy (RADG) with lymph node dissection.

CASE PRESENTATION

A 64-year-old woman diagnosed with early gastric cancer on the posterior midbody of the stomach was referred to our hospital for treatment. Computed tomography showed levocardia and inverted abdominal organs without enlarged lymph nodes or distant metastases. Polysplenia syndrome, intestinal malrotation, and left-sided gallbladder were also detected. RADG with D1+ lymph node dissection and Billroth I reconstruction (delta-shaped anastomosis) were performed using robotics. Hepatopathy caused by a liver retractor and pancreatic fistula were identified during the postoperative course, and the latter was classified as grade II based on Clavien-Dindo classification. The patient was discharged 18 days after the operation.

CONCLUSIONS

Preoperative three-dimensional imaging is beneficial, and anatomical organ identification should be routinely performed, especially in SIP patients. We consider RADG a therapeutic option in SIP patients.

Long-term oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis

BACKGROUND

Robotic gastrectomy (RG) has been a new technical alternative for gastric cancer. However, the long-term oncological outcomes of RG still should be further evaluated. In this meta-analysis, the long-term oncological outcomes of RG and laparoscopic gastrectomy (LG) are compared.

METHODS

Comprehensive searches from various databases are compared in February 2017 to identify that the oncological outcomes of RG and LG are evaluated in gastric cancer patients. The pooled oncological outcomes of the overall survival (OS), disease-free survival (DFS), and the recurrence rate were performed by adopting the meta-analysis to calculate the hazard ratio (HR) or the odds ratio with 95% confidence intervals (CIs).

RESULTS

Five studies that concern retrospective design and prospective data collection and involve 1614 patients were included. All the five studies evaluated OS. Two studies evaluated DFS, while four studies reported the recurrence rate or recurrence cases in RG and LG groups with the long-term follow-up. The pooled analysis showed no significant difference in OS and DFS between RG and LG, without significant between-study heterogeneity. Besides, the recurrence rate between RG and LG had no significant difference without heterogeneity.

CONCLUSIONS

RG could provide comparable long-term oncological outcomes as well as LG for the treatment of gastric cancer. OS, DFS, and the recurrence rate by the long-time follow-up of RG were comparable with LG. Generally speaking, more randomized clinical trials and a larger patient cohort with longer follow-up are still essential to further demonstrate the value of the robotic surgery for gastric cancer.