Published online Mar 21, 2020. doi: 10.3748/wjg.v26.i11.1172
Peer-review started: November 15, 2019
First decision: February 14, 2019
Revised: March 5, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: March 21, 2020
Minimally invasive surgery for gastric cancer (GC) has gained widespread use as a safe curative procedure especially for early GC.
To determine risk factors for postoperative complications after minimally invasive gastrectomy for GC.
Between January 2009 and June 2019, 1716 consecutive patients were referred to our division for primary GC. Among them, 1401 patients who were diagnosed with both clinical and pathological Stage III or lower GC and underwent robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) were enrolled. Retrospective chart review and multivariate analysis were performed for identifying risk factors for postoperative morbidity.
Morbidity following minimally invasive gastrectomy was observed in 7.5% of the patients. Multivariate analyses demonstrated that non-robotic minimally invasive surgery, male gender, and an operative time of ≥ 360 min were significant independent risk factors for morbidity. Therefore, morbidity was compared between RG and LG. Accordingly, propensity-matched cohort analysis revealed that the RG group had significantly fewer intra-abdominal infectious complications than the LG group (2.5% vs 5.9%, respectively; P = 0.038), while no significant differences were noted for other local or systemic complications. Multivariate analyses of the propensity-matched cohort revealed that non-robotic minimally invasive surgery [odds ratio = 2.463 (1.070–5.682); P = 0.034] was a significant independent risk factor for intra-abdominal infectious complications.
The findings showed that robotic surgery might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.
Core tip: This study aimed to determine risk factors for postoperative complications after minimally invasive gastrectomy for gastric cancer. Accordingly, multivariate analysis identified non-robotic minimally invasive surgery as an independent risk factor for postoperative complications. Propensity score matching analysis showed that the robotic gastrectomy group had a significantly lower incidence of intra-abdominal infectious complications compared to the laparoscopic gastrectomy group. Additionally, multivariate analyses in the propensity score-matched cohort showed that non-robotic minimally invasive surgery was a significant independent risk factor for intra-abdominal infectious complications.