Robot-assisted laparoscopic gastrectomy for gastric cancer

Table 1 Robot-assisted laparoscopic gastrectomy series for treatment of gastric cancer

Ref.	Country	Patients (n)	Stage disease	Resection type		Operative time1 (min ± SD)	Blood loss1 (mL ± SD)	Open conversion (%)	Harvested nodes1 (n± SD)	Morbidity (%)	Mortality (%)	Hospital stay1 (d ± SD)
				Total	Subtotal
Anderson et al[7]	United States	7	0-I-II	-	7	420 ± NR	300 ± NR	0	24 ± NR	11.1	0	4 ± NR
Patriti et al[8]	Italy	13	I-II-III	4	9	286 ± 32.6	103 ± 87.5	0	28.1 ± 8.3	7.7	0	11.2 ± 4.3
Song et al[9]	South Korea	100	I-II-III	33	67	231.3 ± 43.2	128.2 ± 217.5	0	36.7 ± NR	13	1	7.8 ± 17.1
Pugliese et al[26]	Italy	18	All stages	-	18	344 ± 62	90 ± 48	12	25 ± 4.5	6	6	10 ± 3
Lee et al[27]	South Korea	12	I	-	12	253.7 ± 53.0	135.8 ± 133.9	0	46.0 ± 25.5	8.3	0	6.6 ± 1.6
D’Annibale et al[28]	Italy	24	I-II-III	11	13	267.5 ± NR	30 ± NR	0	28 ± NR	8.3	0	6 ± NR
Jiang et al[29]	China	120	I-II-III	35	85	245 ± 50	70 ± 45	0.9	22.5 ± 10.7	5	0	6.3 ± 2.6
Isogaki et al[30]	Japan	61	Not reported	14	47	520 ± 177 TG 388 ± 85 SDG	150 ± 234 TG 61.8 ± 46.5 SDG	0	43 ± 14 TG 42 ± 18 SDG	4.9	1.6	13.3 ± NR
Liu et al[31]	China	104	I-II-III	54	50	272.52 ± 53.91	80.78 ± 32.37	2	23.1 ± 5.3	11.5	0	6.2 ± 2.5
Park et al[32]	South Korea	200	All stages	46	154	248.8 ± 55.6	146.1 ± 130.3	7	37.9 ± NR	10	0.5	8.0 ± 3.7
Coratti et al[33]	Itlay	98	All stages	38	60	296.1 ± NR	105.4 ± NR	7.1	30.6 ± NR	12.1	4.1	8.7 ± NR
Tokunaga et al[34]	Japan	120	I	12	108	348.5 ± NR	19 ± NR	2.5	44 ± NR	14.2	0	9 ± NR

¹Mean value. SD: Standard deviation; NR: Not reported; TG: Total gastrectomy; SDG: Subtotal distal gastrectomy.

Table 2 Comparative case-control studies of robot-assisted gastrectomy vs laparoscopic assisted gastrectomy and/or open gastrectomy

Ref.	Subject	Stage disease	Patients (n)			Operation time (min)1	Blood loss (mL)1	Harvested nodes (n)1	Morbidity (%)	Mortality (%)	Hospital stay (d)1
			RAG	LAG	OG
Song et al[35]	RAG vs iLAG2 vs rLAG2	I-II	202	202 202	-	230 vs 289.5 vs 134.1 (RAG < iLAG > rLAG)3	94.8 RAG vs 39.5 rLAG (NS)	35.3 vs 31.5 vs 42.7 (NS)	5 vs 5 vs 10 (NS)	0 vs 0 vs 0	5.7 vs 7.7 vs 6.2 (RAG < iLAG)3 (RAG~rLAG, NS)
Kim et al[36]	RAG vs LAG vs OG	I-II-III	16	11	12	259.2 vs 203.9 vs 126.7 (RAG > LAG > OG)3	30.3 vs 44.7 vs 78.8 (RAG < LAG < OG)3	41.1 vs 37.4 vs 43.3 (NS)	0 vs 10 vs 20 (NS)	0 vs 0 vs 0	5.1 vs 6.5 vs 6.7 (RAG < LAG < OG)3
Eom et al[37]	RAG vs LAG	I-II-III	30	62	-	229.1 vs 189.4 (RAG > LAG)3	152.8 vs 88.3 (NS)	30.2 vs 33.4 (NS)	13.3 vs 6.6 (NS)	0 vs 0	7.9 vs 7.8 (NS)
Woo et al[25]	RAG vs LAG	I-II-III	236	591	-	219.5 vs 170.7 (RAG > LAG)3	91.6 vs 147.9 (RAG < LAG)3	39.0 vs 37.4 (NS)	11 vs 13.7 (NS)	0.4 vs 0.3 (NS)	7.7 vs 7.0 (RAG > LAG)3
Caruso et al[38]	RAG vs OG	All stages	29	-	120	290 vs 222 (RAG > OG)3	197.6 vs 386.1 (RAG < OG)3	28.0 vs 31.7 (RAG~OG)	10.34 vs 10.04 (NS)	0 vs 3.3 (NS)	9.6 vs 13.4 (RAG < OG)3
Huang et al[39]	RAG vs LAG vs OG	I-II-III	39	64	586	430 vs 350 vs 320 (RAG > LAG > OG)3	50 vs 100 vs 400 (RAG < LAG < OG)3	32 vs 26 vs 34 (RAG = OG > LAG)3	15.4 vs 15.6 vs 14.7 (NS)	1.4 vs 1.6 vs 2.6 (NS)	7 vs 11 vs 12 (RAG < LAG < OG)3
Uyama et al[40]	RAG vs LAG	All stages	25	225	-	361 vs 345 (NS)	51.8 vs 81.0 (RAG < LAG)3	44.3 vs 43.2 (NS)	11.2 vs 16.9 (NS)	0 vs 0	12.1 vs 17.3 (RAG < LAG)3
Kang et al[12]	RAG vs LAG	I-II-III	100	282	-	202.05 vs 173.45 (RAG > LAG)3	93.25 vs 173.45 (RAG < LAG)3	NR	14.0 vs 10.3 (NS)	0 vs 0	9.81 vs 8.11 (RAG > LAG)3
Kim et al[41]	RAG vs LAG vs OG	0-I-II-III	436	861	4542	226 vs 176 vs 158 (RAG > LAG > OG)3	85 vs 112 vs 192 (RAG = LAG < OG)3	40.2 vs 37.6 vs 40.5 (RAG = OG > LAG)3	10.1 vs 10.4 vs 10.7 (NS)	0.5 vs 0.3 vs 0.5 (NS)	7.5 vs 7.8 vs 10.2 (RAG = LAG < OG)3
Yoon et al[42]	RAG vs LAG	I-II-III	36	65	-	305.8 vs 210.2 (RAG > LAG)3	NR	42.8 vs 39.4 (NS)	16.7 vs 15.4 (NS)	0 vs 0	8.8 vs 10.3 (NS)
Hyun et al[43]	RAG vs LAG	I-II-III	38	83	-	234.4 vs 220.0 (NS)	131.3 vs 130.48 (NS)	32.8 vs 32.8 (NS)	13.14vs 16.84 (NS)	0 vs 0	10.5 vs 11.9 (NS)
Kim et al[11]	RAG vs LAG	I-II-III	172	481	-	206.4 vs 167.1 (RAG > LAG)3	59.8 vs 134.9 (RAG < OG)3	37.3 vs 36.8 (NS)	5.2 vs 4.2 (NS)	0 vs 0.6 (NS)	7.1 vs 6.7 (NS)
Kim et al[44]	RAG vs LAG	I-II-III	87	288	-	248.4 vs 230.0 (RAG > LAG)3	NR	37.1 vs 34.1 (RAG > LAG)3	5.7 vs 9.0 (RAG < LAG)3	1.1 vs 0.3 (NS)	6.7 vs 7.4 (RAG < LAG)3
Son et al[45]	RAG vs LAG	I-II-III	51	58	-	264.1 vs 210.3 (RAG > LAG)3	163.4 vs 210.7 (NS)	47.2 vs 42.8 (NS)	16 vs 22 (NS)	1.9 vs 0 (NS)	8.6 vs 7.9 (NS)
Park et al[46]	RAG vs LAG	I-II-III	30	120	-	218 vs 140 (RAG > LAG)3	75 vs 60 (NS)	34 vs 35 (NS)	17 vs 7.5 (NS)	0 vs 0	7.0 vs 7.0 (NS)
Junfeng et al[24]	RAG vs LAG	I-II-III	120	394	-	234.8 vs 221.3 (RAG > LAG)3	118.3 vs 137.6 (RAG < LAG)3	34.6 vs 32.7 (RAG > LAG)3	5.8 vs 4.3 (NS)	NR	7.8 vs 7.9 (NS)
Seo et al[47]	RAG vs LAG	I-II-III	40	40	-	243 vs 224 (NS)	76 vs 227 (RAG < LAG)3	40.4 vs 35.4 (NS)	NR	NR	6.75 vs 7.37 (RAG < LAG)3
Shen et al[48]	RAG vs LAG	I-II-III	93	330	-	257.1 vs 226.2 (RAG > LAG)3	176.6 vs 212.5 (RAG < LAG)3	33.0 vs 31.3 (RAG > LAG)3	9.8 vs 10.0 (NS)	NR	9.4 vs 10.6 (NS)
Suda et al[49]	RAG vs LAG	All stages	88	438	-	381 vs 361 (RAG > LAG)3	46 vs 34 (RAG > LAG)3	40 vs 38 (NS)	2.3 vs 11.4 (RAG < LAG)3	1.1 vs 0.2 (NS)	14 vs 15 (RAG < LAG)3
Kim et al[50]	RAG vs LAG	I-II-III	223	211	-	226 vs 180 (RAG > LAG)3	50 vs 60 (NS)	33 vs 32 (NS)	13.5 vs 14.2 (NS)	0 vs 0	7.8 vs 7.9 (NS)

¹Mean value;

²The authors compared 20 gastric cancer patients who underwent robotic gastrectomy with 20 initial patients who underwent laparoscopic subtotal gastrectomy (iLAG) and 20 recent laparoscopic subtotal gastrectomy performed during the same period as the 20 robotic gastrectomy (rLAG);

³Difference statistically significant, P < 0.05;

⁴Major complications rate base on Clavien-Dindo classification ≥ 3, such as anastomotic and duodenal leakage. RAG: Robot-assisted laparoscopic gastrectomy; LAG: Laparoscopic assisted gastrectomy; OG: Open gastrectomy; NR: Not reported; NS: Not statistically significant difference.

Table 3 Meta-analysis comparing robot-assisted gastrectomy with laparoscopic assisted gastrectomy and/or open gastrectomy in the treatment gastric cancer

Ref.	Subject	Patients (n)			Operation time (min)1	Blood loss (mL)1	Harvested nodes (n)1	Morbidity (%)	Mortality (%)	Hospital stay (d)1
		RAG	LAG	OG
Xiong et al[56]	RAG vs LAG	268	650	-	68.772 (RAG > LAG)3	-41.882 (RAG < LAG)3	-0.712 (NS)	0.744 (NS)	1.804 (NS)	-0.542 (NS)
Liao et al[57]	RAG vs OG	520	-	5260	65.732 (RAG > LAG)3	-126.082 (RAG < LAG)3	-0.782 (NS)	0.984 (NS)	0.984 (NS)	-2.872 (RAG < LAG)3
Hyun et al[58]	RAG vs LAG RAG vs OG	634 558	1236 -	- 5301	61.992 (RAG > LAG)3 65.732 (RAG > OG)3	-6.082 (NS) -154.182 (RAG < OG)3	-0.252 (NS) -1.132 (NS)	1.124 (NS) 1.374 (NS)	NR NR	-0.602 (NS) -2.182 (RAG < OG)3
Marano et al[20]	RAG vs OG RAG vs LAG	404 404	- 845	718 -	95.832 (RAG > OG)3 63.702 (RAG > LAG)3	-225.582 (NS) -35.532 (RAG < LAG)3	-2.682 (NS) 0.502 (NS)	0.934 (NS) 0.874 (NS)	NR NR	-2.922 (RAG < OG)3 -0.602 (NS)
Xiong et al[59]	RAG vs LAG	736	1759	-	48.642 (RAG > LAG)3	-33.562 (RAG < LAG)3	1.282 (NS)	1.134 (NS)	1.664 (NS)	-1.162 (NS)
Liao et al[60]	RAG vs LAG	762	1473	-	50.02 (RAG > LAG)3	-46.972 (RAG < LAG)3	1.612 (NS)	0.884 (NS)	0.454 (NS)	-0.52 (NS)
Shen et al[61]	RAG vs LAG	506	1369	-	48.462 (RAG > LAG)3	-38.432 (RAG < LAG)3	1.062 (NS)	0.954 (NS)	NR	-1.02 (NS)
Zong et al[62]	RAG vs OG RAG vs LAG	481 997	- 2207	4674 -	68.472 (RAG > OG)3 57.152 (RAG > LAG)3	-106.632 (RAG < OG)3 -28.592 (NS)	-0.782 (NS) -0.632 (NS)	0.924 (NS) 1.064 (NS)	0.724 (NS) 1.054 (NS)	-2.492 (RAG < OG)3 -0.162 (NS)
Chuan et al[63]	RAG vs LAG	551	1245	-	42.92 (RAG > LAG)3	-16.072 (RAG < LAG)3	2.452 (NS)	1.054 (NS)	NR	-1.982 (RAG < LAG)3

¹Mean value;

²Weighted mean difference;

³Difference statistically significant, P < 0.05;

⁴Odds ratio. RAG: Robot-assisted laparoscopic gastrectomy; LAG: Laparoscopic assisted gastrectomy; OG: Open gastrectomy; NR: Not reported; NS: Not statistically significant difference.