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Lai TJ, Roxburgh C, Boyd KA, Bouttell J. Clinical effectiveness of robotic versus laparoscopic and open surgery: an overview of systematic reviews. BMJ Open 2024; 14:e076750. [PMID: 39284694 PMCID: PMC11409398 DOI: 10.1136/bmjopen-2023-076750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024] Open
Abstract
OBJECTIVE To undertake a review of systematic reviews on the clinical outcomes of robotic-assisted surgery across a mix of intracavity procedures, using evidence mapping to inform the decision makers on the best utilisation of robotic-assisted surgery. ELIGIBILITY CRITERIA We included systematic reviews with randomised controlled trials and non-randomised controlled trials describing any clinical outcomes. DATA SOURCES Ovid Medline, Embase and Cochrane Library from 2017 to 2023. DATA EXTRACTION AND SYNTHESIS We first presented the number of systematic reviews distributed in different specialties. We then mapped the body of evidence across selected procedures and synthesised major findings of clinical outcomes. We used a measurement tool to assess systematic reviews to evaluate the quality of systematic reviews. The overlap of primary studies was managed by the corrected covered area method. RESULTS Our search identified 165 systematic reviews published addressing clinical evidence of robotic-assisted surgery. We found that for all outcomes except operative time, the evidence was largely positive or neutral for robotic-assisted surgery versus both open and laparoscopic alternatives. Evidence was more positive versus open. The evidence for the operative time was mostly negative. We found that most systematic reviews were of low quality due to a failure to deal with the inherent bias in observational evidence. CONCLUSION Robotic surgery has a strong clinical effectiveness evidence base to support the expanded use of robotic-assisted surgery in six common intracavity procedures, which may provide an opportunity to increase the proportion of minimally invasive surgeries. Given the high incremental cost of robotic-assisted surgery and longer operative time, future economic studies are required to determine the optimal use of robotic-assisted surgery capacity.
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Affiliation(s)
- Tzu-Jung Lai
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Campbell Roxburgh
- School of Cancer Sciences, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Janet Bouttell
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
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Hikage M, Kosaka W, Kosaka A, Matsuura T, Horii S, Kawamura K, Yamada M, Hashimoto M, Ito Y, Kusuda K, Shibuya S, Goukon Y. Feasibility of initiating robotic surgery during the early stages of gastrointestinal surgery education. Langenbecks Arch Surg 2024; 409:236. [PMID: 39088125 DOI: 10.1007/s00423-024-03432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/27/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Minimally invasive surgery for gastrointestinal cancers is rapidly advancing; therefore, surgical education must be changed. This study aimed to examine the feasibility of early initiation of robotic surgery education for surgical residents. METHODS The ability of staff physicians and residents to handle robotic surgical instruments was assessed using the da Vinci® skills simulator (DVSS). The short-term outcomes of 32 patients with colon cancer who underwent robot-assisted colectomy (RAC) by staff physicians and residents, supervised by a dual console system, between August 2022 and March 2024 were compared. RESULTS The performances of four basic exercises were assessed after implementation of the DVSS. Residents required less time to complete these exercises and achieved a higher overall score than staff physicians. There were no significant differences in the short-term outcomes, operative time, blood loss, incidence of postoperative complications, and length of the postoperative hospital stay of the two surgeon groups. CONCLUSION Based on the evaluation involving the DVSS and RAC results, it appears feasible to begin robotic surgery training at an early stage of surgical education using a dual console system.
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Affiliation(s)
- Makoto Hikage
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan.
| | - Wataru Kosaka
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Atsumi Kosaka
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Taeko Matsuura
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Shinichiro Horii
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Keiichiro Kawamura
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Masato Yamada
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Munetaka Hashimoto
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Yasushi Ito
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Kazuyuki Kusuda
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Shunsuke Shibuya
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Yuji Goukon
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
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Ruff SM, Dillhoff ME. Minimally Invasive Techniques for Gastrectomy. Surg Oncol Clin N Am 2024; 33:539-547. [PMID: 38789196 DOI: 10.1016/j.soc.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Gastric adenocarcinoma is an aggressive disease and a leading cause of cancer-related deaths worldwide. Surgery entails either a total or a subtotal gastrectomy. These complex operations carry elevated morbidity and mortality with an extended recovery time. As such, research has focused on minimizing these risks and enhancing postoperative care. Robotic surgery is a newer platform that helps overcome some of the limitations of laparoscopy through three-dimensional vision, better mobility, and improved surgeon dexterity. As such, many surgeons have embraced robotics and advocated for their implementation in cancer surgery. This review will discuss the technical considerations of performing a robotic gastrectomy.
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Affiliation(s)
- Samantha M Ruff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Mary E Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; Department of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 320 West 10th Avenue, M-256 Starling Loving Hall, Columbus, OH 43210, USA.
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Thornton R, Davey MG, Kerin MJ. Evaluating the utility of robotic axillary lymph node dissection in patients with invasive breast cancer: a systematic review. Ir J Med Sci 2024; 193:1163-1170. [PMID: 37971673 DOI: 10.1007/s11845-023-03561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Robot-assisted axillary lymph node dissection (RALND) has been proposed to improve surgical and oncological outcomes for patients with breast cancer. To perform a systematic review of current literature evaluating RALND in patients with invasive breast cancer. A systematic search was performed in accordance with the PRISMA guidelines. Studies outlining outcomes following RALND were included. Two studies involving 92 patients were included in this review. Of these, 41 underwent RALND using the da Vinci© robotic system (44.57%), and 51 underwent conventional axillary lymph node dissection (CALND) (55.43%). There was no significant difference observed with respect to intra-operative blood loss or duration of procedure in those undergoing CALND and RALND (P > 0.050). One study reported a significant difference in lymphoedema rates in support of RALND (6.67% vs 26.67%, P = 0.038). Overall, data in relation to postoperative fat necrosis (10.00% vs 33.33%, P = 0.028), wound infection rates (3.33% vs. 20.00%, P = 0.044), and wound ≤ 40 mm in length (63.63% vs. 19.05%, P = 0.020) supported RALND. Oncological outcomes were only reported in one of the studies, which concluded that there was no local or metastatic recurrence in either group at 3-month follow-up. These provisional results support RALND as a safe alternative to CALND. Notwithstanding, the paucity of data limits the robustness of conclusions which may be drawn surrounding the adoption of RALND as the standard of care. Further high-quality studies are required to ratify these findings.
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Affiliation(s)
- Róisín Thornton
- Department of Surgery, University of Galway, Galway, Republic of Ireland.
| | - Matthew G Davey
- Department of Surgery, University of Galway, Galway, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, University of Galway, Galway, Republic of Ireland
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Oberoi M, Noor MS, Abdelfatah E. The Multidisciplinary Approach and Surgical Management of GE Junction Adenocarcinoma. Cancers (Basel) 2024; 16:288. [PMID: 38254779 PMCID: PMC10813924 DOI: 10.3390/cancers16020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Gastroesophageal (GE) junction adenocarcinoma is an aggressive malignancy of growing incidence and is associated with public health issues such as obesity and GERD. Management has evolved over the last two decades to incorporate a multidisciplinary approach, including endoscopic intervention, neoadjuvant chemotherapy/chemoradiation, and minimally invasive or more limited surgical approaches. Surgical approaches include esophagectomy, total gastrectomy, and, more recently, proximal gastrectomy. This review analyzes the evidence for and applicability of these varied approaches in management, as well as areas of continued controversy and investigation.
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Affiliation(s)
| | | | - Eihab Abdelfatah
- Department of Surgery, NYU Langone Health, 120 Mineola Blvd., Suite 320h, Mineola, Long Island, NY 11501, USA; (M.O.); (M.S.N.)
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Rawicz-Pruszyński K, Tsilimigras DI, Endo Y, Munir MM, Katayama E, Benavides JG, Sędłąk K, Pelc Z, Pawlik TM. Improved guideline compliance and textbook oncologic outcomes among patients undergoing multimodal treatment and minimally invasive surgery for locally advanced gastric cancer. J Gastrointest Surg 2024; 28:10-17. [PMID: 38353069 DOI: 10.1016/j.gassur.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although receipt of neoadjuvant chemotherapy has been identified to improve unfavorable survival outcomes among patients with locally advanced gastric cancer (LAGC), several randomized controlled trials have not demonstrated a difference in oncological outcomes/overall survival (OS) among patients undergoing minimally invasive surgery (MIS) versus open gastrectomy. This study aimed to investigate National Comprehensive Cancer Network (NCCN) guideline adherence and textbook oncological outcome (TOO) among patients undergoing MIS versus open surgery for LAGC. METHODS In this cross-sectional study, patients with stage II/III LAGC (cT2-T4N0-3M0) who underwent curative-intent treatment between 2013 and 2019 were evaluated using the National Cancer Database. Multivariable analysis was performed to assess the association between surgical approach, NCCN guideline adherence, TOO, and OS. The study was registered on the International Standard Randomised Controlled Trial Number registry (registration number: ISRCTN53410429) and conducted according to the Strengthening The Reporting Of Cohort Studies in Surgery and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS Among 13,885 patients, median age at diagnosis was 68 years (IQR, 59-76); most patients were male (n = 9887, 71.2%) and identified as White (n = 10,295, 74.1%). Patients who underwent MIS (n = 4692, 33.8%) had improved NCCN guideline adherence and TOO compared with patients who underwent open surgery (51.3% vs 43.5% and 36.7% vs 27.3%, respectively; both P < .001). Adherence to NCCN guidelines and likelihood to achieve TOO increased from 2013 to 2019 (35.6% vs 50.9% and 31.4% vs 46.4%, respectively; both P < .001). Moreover, improved median OS was observed among patients with NCCN guideline adherence and TOO undergoing MIS versus open surgery (57.3 vs 49.8 months [P = .041] and 68.4 vs 60.6 months [P = .025], respectively). CONCLUSIONS An overall increase in guideline-adherent treatment and achievement of TOO among patients with LAGC undergoing multimodal and curative-intent treatment in the United States was observed. Adoption of minimally invasive gastrectomy may result in improved short- and long-term outcomes.
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Affiliation(s)
- Karol Rawicz-Pruszyński
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States; Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Jose Guevara Benavides
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Katarzyna Sędłąk
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States.
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Ergenç M, Uprak TK, Akın Mİ, Hekimoğlu EE, Çelikel ÇA, Yeğen C. Prognostic significance of metastatic lymph node ratio in gastric cancer: a Western-center analysis. BMC Surg 2023; 23:220. [PMID: 37550669 PMCID: PMC10408136 DOI: 10.1186/s12893-023-02127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Tumor-node-metastasis (TNM) staging is the central gastric cancer (GC) staging system, but it has some disadvantages. However, the lymph node ratio (LNR) can be used regardless of the type of lymphadenectomy and is considered an important prognostic factor. This study aimed to evaluate the relationship between LNR and survival in patients who underwent curative GC surgery. METHODS All patients who underwent radical gastric surgery between January 2014 and June 2022 were retrospectively evaluated. Clinicopathological features of tumors, TNM stage, and survival rates were analyzed. LNR was defined as the ratio between metastatic lymph nodes and total lymph nodes removed. The LNR groups were classified as follows: LNR0 = 0, 0.01 < LNR1 ≤ 0.1, 0.1 < LNR2 ≤ 0.25 and LNR3 > 0.25. Tumor characteristics and overall survival (OS) of the patients were compared between LNR groups. RESULTS After exclusion, 333 patients were analyzed. The mean age was 62 ± 14 years. According to the LNR classification, no difference was found between groups regarding age and sex. However, TNM stage III disease was significantly more common in LNR3 patients. Most patients (43.2%, n = 144) were in the LNR3 group. In terms of tumor characteristics (lymphatic, vascular, and perineural invasion), the LNR3 group had significantly poorer prognostic factors. The Cox regression model defined LNR3, TNM stage II-III disease, and advanced age as independent risk factors for survival. Patients with LNR3 demonstrated the lowest 5-year OS rate (35.7%) (estimated mean survival was 30 ± 1.9 months) compared to LNR 0-1-2. CONCLUSION Our study showed that a high LNR was significantly associated with poor OS in patients who underwent curative gastrectomy. LNR can be used as an independent prognostic predictor in GC patients.
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Affiliation(s)
- Muhammer Ergenç
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey.
| | - Tevfik Kıvılcım Uprak
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Muhammed İkbal Akın
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Ece Elif Hekimoğlu
- Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Çiğdem Ataizi Çelikel
- Department of Pathology, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Cumhur Yeğen
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
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