Severity and incidence of complications assessed by the Clavien–Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study
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Robot-assisted gastrectomy (RAG) has been increasingly used for the treatment of advanced gastric cancer (AGC), and many advantages over laparoscopy-assisted gastrectomy (LAG) have been reported. However, its postgastrectomy complications still under investigation and the results remain controversial. This study aimed to objectively assess the incidence and severity of complications following RAG vs. LAG using Clavien–Dindo (C–D) classification and to identify risk factors related to complications.
Five hundred and twenty-seven patients with AGC who underwent RAG or LAG between January 2016 and May 2018 were enrolled in this study. Complications were categorized according to the C–D classification. The complications following RAG and LAG were compared using one-to-one propensity score matching (PSM) analysis and subgroup analyses. Logistic regression analyses were performed to identify risk factors related to complications.
RAG was performed in 251 patients (47.6%) and LAG in 276 patients (52.4%). Before PSM, the RAG group had a smaller tumour size (P = 0.004) and less patients with previous abdominal operation (P = 0.013). After PSM, a well-balanced cohort of 446 patients (223 in each group) was further analyzed. Of interest, the incidence of overall and severe complications (C–D grade ≥ IIIa) following the RAG group were significantly fewer than the LAG group (overall, 24.5% vs. 18.8%, P < 0.001; severe, 8.9% vs. 17.5%, P = 0.002). Subgroup analyses showed statistically significant difference were also observed in most stratified parameters. Multivariable analysis identified age ≥ 65 years, total gastrectomy, stage T3–T4a, stage II–III, and operation time ≥ 250 min as independent predictors of overall complications. Additionally, age ≥ 65 years, stage II–III, and operation time ≥ 250 min were confirmed as independent risk factors for severe complications.
RAG with D2 lymphadenectomy is feasible and safe for the treatment of AGC in terms of the lower incidence and severity of complications.
KeywordsGastric cancer Robot-assisted gastrectomy Laparoscopy-assisted gastrectomy Postoperative complication Clavien–Dindo classification
The authors are grateful to medical staff of Department of General Surgery, Lanzhou General Hospital of Chinese People’s Liberation Army for their management of database.
The original study design was undertaken by HBL, WJW, and HTL. Data collection was undertaken by JPY, LS, PC, LW, CAG, and WH. The Clavien–Dindo grade for each patient was assessed by LY, KL, and YWM, and any divergences on grade were solved by discussion. Data were analysed by WJW, and appraised by HTL, JPY, and HBL. The draft manuscript was written by WJW, and was reviewed and edited by HTL, JPY, LS, PC, YML, and HBL. All authors have seen and approved the final version of the manuscript.
This study was supported by Cuiying Graduate Supervisor Applicant Training Program of Lanzhou University Second Hospital, Huimin plan of Ministry of Science and Technology of China (2012GS620101), Major Projects of Science and Technology of Gansu Province (2011GS04390), Natural Science Foundation of Gansu Province (1506RJZA309), and Postdoctoral Research Foundation of China (2015M572710).
Compliance with ethical standards
Drs. Wen-Jie Wang, Hong-Tao Li, Jian-Ping Yu, Lin Su, Chang-An Guo, Peng Chen, Long Yan, Kun Li, You-Wei Ma, Ling Wang, Wei Hu, Yu-Min Li, and Hong-Bin Liu have no conflicts of interest or financial ties to disclose.
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