Should robotic gastrectomy become a standard surgical treatment option for gastric cancer?

Abstract

Robotic gastrectomy (RG) using the da Vinci Surgical System for gastric cancer was approved for national medical insurance coverage in Japan in April, 2018, and has been used increasingly since. We reviewed the current evidence on RG, open gastrectomy (OG), and conventional laparoscopic gastrectomy (LG) to identify differences in surgical outcomes between Japan and other countries. Briefly, three independent reviewers systematically reviewed the data collected from a comprehensive literature search by an independent organization and focused on the following nine endpoints: mortality, morbidity, operative time, estimated volume of blood loss, length of postoperative hospital stay, long-term oncologic outcome, quality of life, learning curve, and cost. Overall, the mortality rate of the three approaches did not differ, but RG and LG had less intraoperative blood loss and resulted in a shorter postoperative hospital stay than OG. RG had longer operative times and incurred higher costs than LG and OG. However, in Japan, RG may be more effective than LG and OG for decreasing morbidity. Further studies are needed to establish the specific indications for RG, optimal robotic setup, and dissection methods to best utilize the surgical robot.

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References

  1. 1.

    Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.

    PubMed  Google Scholar 

  3. 3.

    Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2016.

  4. 4.

    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer. Ann Surg. 2010;251:417–20.

    PubMed  Google Scholar 

  5. 5.

    Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13:238–44.

    PubMed  Google Scholar 

  6. 6.

    Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20:699–708.

    PubMed  Google Scholar 

  7. 7.

    Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.

    CAS  PubMed  Google Scholar 

  8. 8.

    Uyama I, Suda K, Satoh S. Laparoscopic surgery for advanced gastric cancer: current status and future perspectives. J Gastric Cancer. 2013;13:19–25.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Robotic surgery for upper gastrointestinal cancer: current status and future perspectives. Dig Endosc. 2016;28:701–13.

    PubMed  Google Scholar 

  10. 10.

    Yoshida K, Honda M, Kumamaru H, Kodera Y, Kakeji Y, Hiki N, et al. Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: a retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg. 2018;2:55–64.

    PubMed  Google Scholar 

  11. 11.

    Hiki N, Honda M, Etoh T, Yoshida K, Kodera Y, Kakeji Y, et al. Higher incidence of pancreatic fistula in laparoscopic gastrectomy Real-world evidence from a nationwide prospective cohort study. Gastric Cancer. 2018;21:162–70.

    PubMed  Google Scholar 

  12. 12.

    Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, et al. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer. 2019;22:202–13.

    PubMed  Google Scholar 

  13. 13.

    Nakauchi M, Uyama I, Suda K, Mahran M, Nakamura T, Shibasaki S, et al. Robotic surgery for the upper gastrointestinal tract: current status and future perspectives. Asian J Endosc Surg. 2017;10:354–63.

    PubMed  Google Scholar 

  14. 14.

    Hashizume M, Sugimachi K. Robot-assisted gastric surgery. Surg Clin N Am. 2003;83:1429–44.

    PubMed  Google Scholar 

  15. 15.

    Uyama I, Suda K, Nakauchi M, Kinoshita T, Noshiro H, Takiguchi S, et al. Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer. 2019;22:377–85.

    PubMed  Google Scholar 

  16. 16.

    Wang G, Jiang Z, Zhao J, Liu J, Zhang S, Zhao K, et al. Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer: a randomized clinical trial. J Surg Oncol. 2016;113:397–404.

    PubMed  Google Scholar 

  17. 17.

    Pan HF, Wang G, Liu J, Liu XX, Zhao K, Tang XF, Jiang ZW. Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer. Surg Laparosc Endosc Percutan Tech. 2017;27:428–33.

    PubMed  Google Scholar 

  18. 18.

    Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, et al. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg. 2016;263:103–9.

    PubMed  Google Scholar 

  19. 19.

    Okabe H, Obama K, Tsunoda S, Matsuo K, Tanaka E, Hisamori S, et al. Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer. Surg Today. 2019. https://doi.org/10.1007/s00595-019-01802-z(Epub ahead of print).

    Article  PubMed  Google Scholar 

  20. 20.

    Park JY, Eom BW, Jo MJ, Yoon HM, Ryu KW, Kim YW, et al. Health-related quality of life after robot-assisted distal gastrectomy in early gastric cancer. World J Surg. 2014;38:1112–20.

    PubMed  Google Scholar 

  21. 21.

    Tokunaga M, Makuuchi R, Miki Y, Tanizawa Y, Bando E, Kawamura T, Terashima M. Late phase II study of robot-assisted gastrectomy with nodal dissection for clinical stage I gastric cancer. Surg Endosc. 2016;30:3362–7.

    PubMed  Google Scholar 

  22. 22.

    Greenleaf EK, Sun SX, Hollenbeak CS, Wong J. Minimally invasive surgery for gastric cancer: the American experience. Gastric Cancer. 2017;20:368–78.

    PubMed  Google Scholar 

  23. 23.

    Parisi A, Reim D, Borghi F, Nguyen NT, Qi F, Coratti A, et al. Minimally invasive surgery for gastric cancer: a comparison between robotic, laparoscopic and open surgery. World J Gastroenterol. 2017;23:2376–84.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Wang WJ, Li HT, Yu JP, Su L, Guo CA, Chen P, et al. 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. Surg Endosc. 2018. https://doi.org/10.1007/s00464-018-06624-7(Epub ahead of print).

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Gao Y, Xi H, Qiao Z, Li J, Zhang K, Xie T, et al. Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: update short- and long-term results. Surg Endosc. 2019;33:528–34.

    PubMed  Google Scholar 

  26. 26.

    Yang SY, Roh KH, Kim YN, Cho M, Lim SH, Son T, et al. Surgical outcomes after open, laparoscopic, and robotic gastrectomy for gastric cancer. Ann Surg Oncol. 2017;24:1770–7.

    PubMed  Google Scholar 

  27. 27.

    Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z, Yongliang Z, et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc. 2014;28:1779–877.

    PubMed  Google Scholar 

  28. 28.

    Kim KM, An JY, Kim HI, Cheong JH, Hyung WJ, Noh SH. Major early complications following open, laparoscopic and robotic gastrectomy. Br J Surg. 2012;99:1681–7.

    CAS  PubMed  Google Scholar 

  29. 29.

    Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, et al. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg (Chicago, Ill. 1960). 2011;146:1086–92.

    Google Scholar 

  30. 30.

    Suda K, Man-i M, Ishida Y, Kawamura Y, Satoh S, Uyama I. Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc. 2015;29:673–85.

    PubMed  Google Scholar 

  31. 31.

    Noshiro H, Ikeda O, Urata M. Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone. Surg Endosc. 2014;28:1180–7.

    PubMed  Google Scholar 

  32. 32.

    Obama K, Kim YM, Kang DR, Son T, Kim HI, Noh SH, Hyung WJ. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer. 2018;21:285–95.

    PubMed  Google Scholar 

  33. 33.

    Coratti A, Fernandes E, Lombardi A, Di Marino M, Annecchiarico M, Felicioni L, Giulianotti PC. Robot-assisted surgery for gastric carcinoma: five years follow-up and beyond: a single western center experience and long-term oncological outcomes. Eur J Surg Oncol. 2015;41:1106–13.

    CAS  PubMed  Google Scholar 

  34. 34.

    Nakauchi M, Suda K, Susumu S, Kadoya S, Inaba K, Ishida Y, et al. Comparison of the long-term outcomes of robotic radical gastrectomy for gastric cancer and conventional laparoscopic approach: a single institutional retrospective cohort study. Surg Endosc. 2016;30:5444–522.

    PubMed  Google Scholar 

  35. 35.

    Zhou J, Shi Y, Qian F, Tang B, Hao Y, Zhao Y, Yu P. Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol. 2015;111:760–7.

    PubMed  Google Scholar 

  36. 36.

    Park SS, Kim MC, Park MS, Hyung WJ. Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc. 2012;26:60–7.

    PubMed  Google Scholar 

  37. 37.

    Huang KH, Lan Y, Fang WL, Chen JH, Lo SS, Li AF, et al. Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS O ne. 2014;9:e111499.

    Google Scholar 

  38. 38.

    Hyun MH, Lee CH, Kim HJ, Tong Y, Park SS. Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma. Br J Surg. 2013;100:1566–78.

    CAS  PubMed  Google Scholar 

  39. 39.

    Yang Y, Wang G, He J, Wu F, Ren S. Robotic gastrectomy versus open gastrectomy in the treatment of gastric cancer. J Cancer Res Clin Oncol. 2017;143:105–14.

    PubMed  Google Scholar 

  40. 40.

    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    PubMed  Google Scholar 

  42. 42.

    Lee JH, Park DJ, Kim HH, Lee HJ, Yang HK. Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien-Dindo classification. Surg Endosc. 2012;26:1287–95.

    PubMed  Google Scholar 

  43. 43.

    Liu H, Kinoshita T, Tonouchi A, Kaito A, Tokunaga M. What are the reasons for a longer operation time in robotic gastrectomy than in laparoscopic gastrectomy for stomach cancer? Surg Endosc. 2019;33:192–8.

    PubMed  Google Scholar 

  44. 44.

    Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Minimally invasive surgery for upper gastrointestinal cancer: our experience and review of the literature. World J Gastroenterol. 2016;22:4626–37.

    PubMed  PubMed Central  Google Scholar 

  45. 45.

    Son T, Hyung WJ. Robotic gastrectomy for gastric cancer. J Surg Oncol. 2015;112:271–8.

    PubMed  Google Scholar 

  46. 46.

    Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S. Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg. 2012;36:331–7.

    PubMed  Google Scholar 

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This work was not supported by any specific grants or funding.

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Correspondence to Koichi Suda.

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K.S. has a financial relationship with Medicaroid, Inc. (Advisory fee, 900 USD/M) outside the submitted work. S.S., K.O., M.Y., and I.U. have no conflicts of interest.

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Shibasaki, S., Suda, K., Obama, K. et al. Should robotic gastrectomy become a standard surgical treatment option for gastric cancer?. Surg Today 50, 955–965 (2020). https://doi.org/10.1007/s00595-019-01875-w

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Keywords

  • Stomach neoplasms
  • Minimally invasive surgical procedures
  • Robotics
  • Gastrectomy