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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis
Stefano Caruso, Alberto Patriti, Franco Roviello, Lorenzo De Franco, Franco Franceschini, Graziano Ceccarelli, Andrea Coratti
Stefano Caruso, Franco Franceschini, Department of General Surgery and Surgical Specialties, Unit of General Surgery, “Santa Maria Annunziata” Hospital, Local Health Unit Center Tuscany Company, 50012 Florence, Italy
Alberto Patriti, Department of Surgery, Division of General Surgery, Hospitals of Pesaro and Fano, “Ospedali Riuniti Marche Nord” Hospital Company, 61032 Marche, Italy
Franco Roviello, Lorenzo De Franco, Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, 53100 Siena, Italy
Graziano Ceccarelli, Department of Medicine and General Surgery, Unit of Minimally Invasive and General Surgery, Local health Unit South-Est Tuscany Company, “San Donato” Hospital, 52100 Arezzo, Italy
Andrea Coratti, Division of Oncological and Robotic General Surgery, “Careggi” University Hospital, 50134 Florence, Italy
Author contributions: Caruso S conceived the design of the study, directed the acquisition of data, the analysis and interpretation of data; De Franco L and Franceschini F performed the literature search, the acquisition of data, the analysis and interpretation of data; Patriti A, Roviello F, Ceccarelli G and Coratti A contributed to the critical appraisal of the work, revising the article critically for important intellectual content and supervising the interpretation of data for final approval.
Conflict-of-interest statement: All authors disclose any potential or actual personal, political or financial conflict of interest in the material, information or techniques described in the paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Stefano Caruso, MD, Department of General Surgery and Surgical Specialties, Unit of General Surgery, “Santa Maria Annunziata” Hospital, Local Health Unit Center Tuscany Company, ASL Firenze, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy. stefano.caruso@teletu.it
Telephone: +39-55-9508373
Received: January 26, 2017
Peer-review started: February 8, 2017
First decision: March 8, 2017
Revised: April 25, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: June 10, 2017
AIM
To evaluate the potential effectiveness of robot-assisted gastrectomy (RAG) in comparison to open gastrectomy (OG) for gastric cancer patients.
METHODS
A comprehensive systematic literature search using PubMed, EMBASE, and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer. Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy. A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, morbidity, and hospital stay. Secondary among postoperative complications, wound infection, bleeding and anastomotic leakage were also analysed.
RESULTS
A total of 6 articles, 5 retrospective and 1 randomized controlled study, involving 6123 patients overall, with 689 (11.3%) cases submitted to RAG and 5434 (88.7%) to OG, satisfied the eligibility criteria and were included in the meta-analysis. RAG was associated with longer operation time than OG (weighted mean difference 72.20 min; P < 0.001), but with reduction in blood loss and shorter hospital stay (weighted mean difference -166.83 mL and -1.97 d respectively; P < 0.001). No differences were found with respect to overall postoperative complications (P = 0.65), wound infection (P = 0.35), bleeding (P = 0.65), and anastomotic leakage (P = 0.06). The postoperative mortality rates were similar between the two groups. With respect to oncological outcomes, no statistical differences among the number of harvested lymph nodes were found (weighted mean difference -1.12; P = 0.10).
CONCLUSION
RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.
Core tip: We took into consideration how safe and efficient robot-assisted gastrectomy (RAG) is compared to open gastrectomy (OG) for gastric cancer via systematic review and meta-analysis. The available studies to date and the analysis of pooled data extracted from these showed that RAG is safe and feasible, making it possible to obtain lower blood loss related to surgery and a more rapid patient recovery. At the same time similar lymph node dissection between the two techniques were revealed. We can reasonably expect that the innovative robotic technique could represent a valid alternative with potential benefit to equal oncological adequacy with respect to OG.
