Advertisement

Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies

  • Zheng Bobo
  • Wang Xin
  • Li Jiang
  • Wang Quan
  • Bi Liang
  • Deng Xiangbing
  • Wang ZiqiangEmail author
Review Article
First Online:

Abstract

Background

To evaluate short- and long-term outcomes of robotic gastrectomy (RG) in patients with gastric cancer to determine whether RG is an acceptable alternative to laparoscopic gastrectomy (LG).

Methods

PubMed, Embase, the Cochrane Library, and Chinese Biomedical Database were searched for prospective observational studies (POSs) comparing RG with LG for gastric cancer until October 2017. We compared short-term and long-term outcomes using systematic review with meta-analysis and trial sequential analysis (TSA).

Results

Sixteen POSs including 4576 patients were included in the meta-analyses. Compared with LG, RG had longer operative time (MD 57.98 min, P < 0.00001), lesser blood loss (MD − 23.71 ml, P = 0.005), and shorter time to first post-operative flatulence (MD − 0.14 days, P = 0.03). No significant difference was found in terms of the number of harvested lymph nodes, complications, reoperation, mortality, open conversion, proximal resection margin, and distal resection margin. The meta-analyses of complications, overall survival, and disease-free survival did not yield any sign of statistically significant difference between the two treatments, and the cumulative Z-curve crossed neither the traditional boundary nor the trial sequential monitoring boundary, suggesting the lack of firm evidence. TSA demonstrated that the cumulative Z-curve crossed either the traditional boundary or the trial sequential monitoring boundary on blood loss and operative time.

Conclusions

The present study demonstrates that RG is as acceptable as LG in terms of short- and long-term outcomes. The TSA demonstrated that further studies are not needed to evaluate the operative time and blood loss differences between these techniques.

Keywords

Robotic Laparoscopic Gastrectomy Gastric cancer 
This is a preview of subscription content, log in to check access.

Notes

Funding

None.

Compliance with ethical standards

Disclosures

Zheng Bobo, Wang Xin, Li Jiang, Wang Quan, Bi Liang, Deng Xiangbing and Wang Ziqiang have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148Google Scholar
  2. 2.
    Qiu J, Pankaj P, Jiang H, Zeng Y, Wu H (2013) Laparoscopy versus open distal gastrectomy for advanced gastric cancer: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 23:1–7CrossRefGoogle Scholar
  3. 3.
    Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52CrossRefGoogle Scholar
  4. 4.
    Ding J, Liao GQ, Liu HL, Liu S, Tang J (2012) Meta-analysis of laparoscopy-assisted distal nastrectomy with D2 lymph node dissection for gastric cancer. J Surg Oncol 105:297–303CrossRefGoogle Scholar
  5. 5.
    Yakoub D, Athanasiou T, Tekkis P, Hanna GB (2009) Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach? Surg Oncol 18:322–333CrossRefGoogle Scholar
  6. 6.
    Lee JH, Han HS (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173CrossRefGoogle Scholar
  7. 7.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefGoogle Scholar
  8. 8.
    Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487CrossRefGoogle Scholar
  9. 9.
    Kim MC, Jung GJ, Kim HH (2005) Learning curve of laparoscopy assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 11:7508–7511CrossRefGoogle Scholar
  10. 10.
    Jin SH, Kim DY, Kim H, Jeong IH, Kim MW (2007) Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 21:28–33CrossRefGoogle Scholar
  11. 11.
    Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14–21CrossRefGoogle Scholar
  12. 12.
    Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P (2004) Robot-assisted abdominal surgery. Br J Surg 91:1390–1397CrossRefGoogle Scholar
  13. 13.
    Hashizume M, Sugimachi K (2003) Robot-assisted gastric surgery. Surg Clin North Am 83:1429–1444CrossRefGoogle Scholar
  14. 14.
    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784CrossRefGoogle Scholar
  15. 15.
    Hyung WJ (2007) Robotic surgery in gastrointestinal surgery. Korean J Gastroenterol 50:256–259Google Scholar
  16. 16.
    Baek SJ, Lee DW, Park SS, Kim SH (2011) Current status of robot-assisted gastric surgery. World J Gastrointest Oncol 3:137–143CrossRefGoogle Scholar
  17. 17.
    Buchs NC, Bucher P, Pugin F, Morel P (2011) Robot-assisted gastrectomy for cancer. Minerva Gastroenterol Dietol 57:33–42Google Scholar
  18. 18.
    Pan JH, Zhou H, Zhao XX, Ding H, Qin L, Pan YL(2017) Long-term oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis. Surg Endosc.  https://doi.org/10.1007/s00464-017-5891-4 Google Scholar
  19. 19.
    Chen K, Pan Y, Zhang B, Maher H, Wang XF, Cai XJ (2017) Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg 24(1):93CrossRefGoogle Scholar
  20. 20.
    Shen WS, Xi HQ, Chen L, Wei B (2014) A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc 28:2795–2802CrossRefGoogle Scholar
  21. 21.
    Borm GF, Donders AR (2009) Updating meta-analyses leads to larger type I errors than publication bias. J Clin Epidemiol 62:825–830CrossRefGoogle Scholar
  22. 22.
    Wetterslev J, Thorlund K, Brok J, Gluud C. Trial (2008) sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 61:64–75CrossRefGoogle Scholar
  23. 23.
    Thorlund K, Devereaux PJ, Wetterslev J, Guyatt G, Ioannidis JP, Thabane L, Gluud LL, Als-Nielsen B, Gluud C (2009) Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses? Int J Epidemiol 38:276–286CrossRefGoogle Scholar
  24. 24.
    Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ott. Hosp. Res. Inst. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
  25. 25.
    Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926CrossRefGoogle Scholar
  26. 26.
    Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834CrossRefGoogle Scholar
  27. 27.
    Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8:16CrossRefGoogle Scholar
  28. 28.
    Brok J, Thorlund K, Gluud C, Wetterslev J (2008) Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. J Clin Epidemiol 61:763–769CrossRefGoogle Scholar
  29. 29.
    Brok J, Thorlund K, Wetterslev J, Gluud C (2009) Apparently conclusive meta-analyses may be inconclusive - Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. Int J Epidemiol 38:287–298CrossRefGoogle Scholar
  30. 30.
    Thorlund K, Engstrøm J, Wetterslev J, Brok J, Imberger G, Gluud C (2011) User Manual for Trial Sequential Analysis (TSA), Copenhagen Trial Unit, Centre for Clinical Intervention Research. http://www.ctu.dk/tsa
  31. 31.
    Pugliese R, Maggioni D, Sansonna F, Costanzi A, Ferrari GC (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602CrossRefGoogle Scholar
  32. 32.
    Kim MC, Heo GU, Jung GJ (2010) Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 24:610–615CrossRefGoogle Scholar
  33. 33.
    Kim KM, An JY, Kim HI, Cheong JH, Hyung WJ, Noh SH (2012) Major early complications following open, laparoscopic and robotic gastrectomy. Br J Surg 99:1681–1687CrossRefGoogle Scholar
  34. 34.
    Son SY, Lee CM, Ahn SH, Lee JH, Park DJ, Kim HH (2012) Clinical outcome of robotic Gastrectomy in gastric cancer in comparison with laparoscopic Gastrectomy: a case-control study. J Min Invas Surg 15:27–31CrossRefGoogle Scholar
  35. 35.
    Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han SU (2012) Comparison of surgical outcomes between robotic and laparoscopic Gastrectomy for gastric cancer:the learning curve of robotic surgery. J Gastric Cancer 12:156–163CrossRefGoogle Scholar
  36. 36.
    Hyun MH1, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH, Kim JH, Park SH, Mok YJ, Park SS (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20:1258–1265CrossRefGoogle Scholar
  37. 37.
    Zhao Kun P, Huafeng W, Gang-Li M, Hu W, Jiang Zhiwei (2013) Contrast study of short-term effect between the Da Vinci surgical robot and laparoscopic technology in patients after distal gastric cancer surgery. Chin J Pract Surg 4:325–327Google Scholar
  38. 38.
    Xue Yonggan Z, Bingdong L, Peng L, Hongyi, Jia Baoqin (2014) Evaluation of clinical short-term outcomes of da Vinci robotic gastrectomy. Chin J Laparosc Surg (Electronic Edition) 7:443–446Google Scholar
  39. 39.
    Son T, Lee JH, Kim YM, Kim HI, Noh SH, Hyung WJ (2014) Robotic spleenpreserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 28:2606–2615CrossRefGoogle Scholar
  40. 40.
    Noshiro H, Ikeda O, Urata M (2014) Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone. Surg Endosc 28:1180–1187CrossRefGoogle Scholar
  41. 41.
    Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Li AF, Chiou SH, Wu CW, Shyr YM (2014) Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS ONE 9:e111499CrossRefGoogle Scholar
  42. 42.
    Park JY1, Ryu KW, Reim D, Eom BW, Yoon HM, Rho JY, Choi IJ, Kim YW (2015) Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy? World J Surg 39:1789–1797CrossRefGoogle Scholar
  43. 43.
    Lee J, Kim YM, Woo Y, Obama K, Noh SH, Hyung WJ (2015) Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc 29:3251–3260CrossRefGoogle Scholar
  44. 44.
    Kim HI1, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, Park JM, An JY, Kim MC, Park S, Song KY, Oh SJ, Kong SH, Suh BJ, Yang DH, Ha TK, Kim YN, Hyung WJ (2016) Multicenter prospective comparative study of robotic versus laparoscopic Gastrectomy for gastric Adenocarcinoma. Ann Surg 263:103–109CrossRefGoogle Scholar
  45. 45.
    Okumura N, Son T, Kim YM, Kim HI, An JY, Noh SH, Hyung WJ (2016) Robotic gastrectomy for elderly gastric cancer patients: comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly. Gastric Cancer 19:1125–1134CrossRefGoogle Scholar
  46. 46.
    Parisi A, Reim D, Borghi F, Nguyen NT, Qi F, Coratti A, Cianchi F, Cesari M, Bazzocchi F, Alimoglu O, Gagnière J, Pernazza G, D’Imporzano S, Zhou YB, Azagra JS, Facy O, Brower ST, Jiang ZW, Zang L, Isik A, Gemini A, Trastulli S, Novotny A, Marano A, Liu T, Annecchiarico M, Badii B, Arcuri G, Avanzolini A, Leblebici M, Pezet D, Cao SG, Goergen M, Zhang S, Palazzini G, D’Andrea V, Desiderio J (2017) Minimally invasive surgery for gastric cancer: a comparison between robotic, laparoscopic and open surgery. World J Gastroenterol 23:2376–2384CrossRefGoogle Scholar
  47. 47.
    Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH (2009) Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc 23:1204–1211CrossRefGoogle Scholar
  48. 48.
    NCCN. Clinical Practice Guidelines in Oncology: Gastric Cancer. http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf
  49. 49.
    Japanese gastric cancer treatment (2011) guidelines 2010 (ver. 3). Gastric cancer 14:113–123 DOI: 10.1007/s10120-011-0042-4CrossRefGoogle Scholar
  50. 50.
    Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg 238:680–685CrossRefGoogle Scholar
  51. 51.
    Yasuda K, Inomata M, Shiraishi N, Izumi K, Ishikawa K (2004) Laparoscopy-assisted distal gastrectomy for early gastric cancer in obese and nonobese patients. Surg Endosc 18:1253–1256CrossRefGoogle Scholar
  52. 52.
    Obama K, Kim YM, Kang DR, Son T, Kim HI, Noh SH, Hyung WJ (2017) Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer.  https://doi.org/10.1007/s10120-017-0740-7.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Zheng Bobo
    • 1
  • Wang Xin
    • 2
  • Li Jiang
    • 3
  • Wang Quan
    • 4
  • Bi Liang
    • 1
  • Deng Xiangbing
    • 1
  • Wang Ziqiang
    • 1
    Email author
  1. 1.Department of Gastrointestinal Surgery, West China HospitalSichuan UniversityChengduChina
  2. 2.Department of GastroenterologyFirst Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  3. 3.Cancer HospitalNational Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical CollegeBeijingChina
  4. 4.Digestive Disease Hospital, Xijing HospitalThe Fourth Military Medical UniversityXi’anChina

Personalised recommendations

Cite article

Buy options