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. However, several recent studies using the nationwide web-based database of Japan have revealed that laparoscopic gastrectomy (LG) promoted higher postoperative local complications compared with open gastrectomy.
We launched robotic gastrectomy (RG) for GC in 2009. Our previous studies have consistently suggested that use of the surgical robot in LG might reduce postoperative complications, although use of the surgical robot was determined in a non-randomized manner. Actually, only experienced surgeons have performed RG, and RG was used for patients who hoped for uninsured use of the robot between 2009 and 2017.
This study aimed to determine risk factors for postoperative complications after minimally invasive gastrectomy for GC using our prospectively maintained database between January 2009 and June 2019.
This study enrolled 1401 patients who underwent radical robotic gastrectomy (RG) or LG for clinical and pathological Stage III or lower GC. Retrospective chart review and multivariate analysis were performed for identifying risk factors for postoperative morbidity.
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 using propensity score matched analysis. As a result, RG induced significantly fewer intra-abdominal infectious complications than the LG (2.5% vs 5.9%, respectively; P = 0.038). Multivariate analyses of the propensity-matched cohort revealed that non-robotic minimally invasive surgery [OR = 2.463 (1.070–5.682); P = 0.034] was a significant independent risk factor for intra-abdominal infectious complications.
RG might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.
We will conduct an RCT on this topic in the near future. Impact of RG on long-term outcomes should also be examined at least in this cohort.