Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2020; 26(11): 1172-1184
Published online Mar 21, 2020. doi: 10.3748/wjg.v26.i11.1172
Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis
Susumu Shibasaki, Koichi Suda, Masaya Nakauchi, Kenichi Nakamura, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama
Susumu Shibasaki, Koichi Suda, Masaya Nakauchi, Kenichi Nakamura, Kazuki Inaba, Ichiro Uyama, Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
Koichi Suda, Kenji Kikuchi, Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
Author contributions: Shibasaki S, Suda K, and Uyama I made substantial contributions to conception and design of the study; Shibasaki S, Nakauchi M, Nakamura K, Kikuchi K, and Inaba K contributed to acquisition, analysis, or interpretation of the data; Shibasaki S and Nakauchi M performed the statistical analysis; Shibasaki S, 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.
Informed consent statement: Informed consent was obtained from all patients.
Institutional review board statement: This study was approved by the institutional review board of Fujita Health University.
Conflict-of-interest statement: All the authors except for I. U. have no commercial association with or financial involvement that might pose a conflict of interest in connection with the submitted article. I. U. has received lecture fees from Intuitive Surgical, Inc.. K. S. and K. K. have been funded by Medicaroid, Inc. in relation to Collaborative Laboratory for Research and Development in Advanced Surgical Technology. K.S. has also received advisory fees from Medicaroid, Inc. outside of the submitted work.
STROBE statement: Authors have read the STROBE Statement checklist of items and the manuscript was prepared and revised accordingly.
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:
Corresponding author: Koichi Suda, FACS, MD, PhD, Professor, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Aichi, Japan.
Received: November 15, 2019
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

RG might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.

Research perspectives

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.