Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2021; 27(39): 6659-6672
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6659
Prognostic factors of minimally invasive surgery for gastric cancer: Does robotic gastrectomy bring oncological benefit?
Masaya Nakauchi, Koichi Suda, Susumu Shibasaki, Kenichi Nakamura, Shinichi Kadoya, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama
Masaya Nakauchi, Koichi Suda, Susumu Shibasaki, Kenichi Nakamura, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama, Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
Shinichi Kadoya, Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8535, Ishikawa, Japan
Author contributions: Nakauchi M, Suda K, Shibasaki S, and Uyama I provided substantial contributions to the conception and design of the study; Nakauchi M, Shibasaki S, Nakamura K, Kikuchi K, Kadoya S, and Inaba K contributed to the acquisition, analysis, and interpretation of the data; Nakauchi M performed the statistical analysis; Nakauchi M, Suda K, and Uyama I drafted the article and made critical revisions related to important intellectual content of the manuscript; all the authors have read and approved the final version to be published.
Institutional review board statement: This study was approved by the institutional review board of Fujita Health University.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: All authors have no commercial association or financial involvement that might pose a conflict of interest in connection with the submitted article. I. U. received lecture fees from Intuitive Surgical, Inc. K. S. and K. K. received funding from Medicaroid, Inc. in relation to Collaborative Laboratory for Research and Development in Advanced Surgical Technology. K.S. also received advisory fees from Medicaroid, Inc. outside of the submitted work.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Koichi Suda, FACS, MD, PhD, Professor, Department of Gastroenterological Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Aichi, Japan. ko-suda@nifty.com
Received: April 26, 2021
Peer-review started: April 26, 2021
First decision: June 13, 2021
Revised: June 18, 2021
Accepted: September 23, 2021
Article in press: September 23, 2021
Published online: October 21, 2021
ARTICLE HIGHLIGHTS
Research background

Minimally invasive surgery (MIS) including laparoscopic and robotic approaches for gastric cancer has been increasingly used because of its beneficial short-term effects over the open approach. However, oncological outcomes are not established.

Research motivation

There have been few reports on the oncological outcomes of MIS for gastric cancer patients, especially for the robotic approach, because a surgical robot remains a relatively new technology. Therefore, this study aimed to determine the prognostic factors of minimally invasive gastrectomy, including laparoscopic and robotic approaches.

Research objectives

This study aimed to determine the prognostic factors of minimally invasive gastrectomy, including laparoscopic and robotic approaches.

Research methods

This single-institutional retrospective cohort study included 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy between 2009 and 2014. We retrospectively examined 5-year overall survival and recurrence-free survival and investigated factors related to survival.

Research results

Age > 65 years, American Society of Anesthesiologists (ASA) physical status 3, total or proximal gastrectomy, and pathological T4 and N positive status were independent predictors of overall survival and recurrence-free survival. The five-year overall survival and recurrence-free survival were 80.3% and 78.2%, respectively. Of all 814 patients, 157 patients (19.3%) underwent robotic gastrectomy and 308 (37.2%) were diagnosed with pathological stage II or III disease. Robotic gastrectomy was an independent positive predictor for recurrence-free survival in pathological stage II/III patients (hazard ratio: 0.56 [0.33-0.96], P = 0.035). Comparison of recurrence-free survival between robotic and laparoscopic approach using propensity score matching analysis verified that with less morbidity in the robotic group (P = 0.005).

Research conclusions

Age, ASA status, type of gastrectomy, and pathological T and N status were prognostic factors of minimally invasive gastrectomy for gastric cancer, and the use of a surgical robot may improve its long-term outcomes for advanced gastric cancer.

Research perspectives

Future studies to better prove the efficacy of robotic gastrectomy for advanced gastric cancer patients are warranted.