Comparison of short‑term outcomes and 3-year overall survival between robotic and laparoscopic gastrectomy for gastric cancer: a propensity score matching analysis

Abstract

Background

Despite the increasing use of robotic gastrectomy (RG) as an alternative to laparoscopic gastrectomy (LG) in treating gastric cancer, controversy remains over the advantages of RG compared to LG and there is a paucity of studies comparing the two techniques regarding patient survival.

Methods

In this retrospective cohort study, 675 patients undergoing minimally invasive gastrectomy were recruited from January 2016 to January 2018 (LG: n = 567; RG: n = 108). A one-to-one propensity score matching (PSM) analysis was applied to minimize the selection bias due to confounding factors, yielding 104 patients in each of the RG and LG groups. After matching, the short-term outcomes and 3-year overall survival were compared in the two groups.

Results

The PSM cohort analysis showed a similar 3-year overall survival between RG and LG groups (p = .249). Concerning the short-term outcomes, the RG compared to LG resulted in lower blood loss (p = .01), lower postoperative complications (p = .001), lower postoperative pain (p = .016), earlier initiation of soft diet (p = .011), shorter hospital stay ‌(p = .012), but higher hospitalization expenses (p = .001).

Conclusion

Our findings suggest that RG may offer advantages in terms of blood loss, surgical complications, recovery time, and pain management compared to LG while maintaining similar overall survival rates. However, RG is associated with higher hospital costs, potentially limiting its wider adoption. Further research, including large, multi-center randomized controlled trials with longer patient follow-up, particularly for advanced gastric cancer, is needed to confirm these findings.

Keywords:

• Robotic gastrectomy
• laparoscopic gastrectomy
• gastric cancer
• propensity score matching

Authors’ contribution

Conceptualization: [Li Zhang, Jingli Cui, Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang]; Methodology: [Li Zhang, Jingli Cui, Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang]; Software: [Li Zhang, Jingli Cui, Gang Ma, Xuejun Wang, Han Liang, Jilong Yang]; Validation: [Li Zhang, Jingli Cui, Gang Ma, Xuejun Wang, Han Liang, Jilong Yang]; Formal analysis: [Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang]; Investigation: [Li Zhang, Jingli Cui, Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang]; Resources: [Li Zhang, Jingli Cui, Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang]; Data Curation: [Li Zhang, Jingli Cui, Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang]; Writing - Original Draft: [Li Zhang, Jingli Cui, Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang]; Writing - Review & Editing: [Li Zhang, Jingli Cui, Han Liang, Jilong Yang]; Visualization: [Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang]; Supervision: [Li Zhang, Jingli Cui, Han Liang, Jilong Yang]; Project administration: [Li Zhang, Jingli Cui, Han Liang, Jilong Yang]; Funding acquisition: [Li Zhang, Jingli Cui, Mingzhi Cai, Bin Li, Gang Ma, Xuejun Wang, Yong Liu, Jingyu Deng, Rupeng Zhang, Han Liang, Jilong Yang].

Ethics approval

Ethical approval was waived by the local Ethics Committee of the Tianjin Cancer Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Consent to participate

The need for written informed consent was waived by the local Ethics Committee of the Tianjin Cancer Hospital due to retrospective nature of the study.

Disclosure statement

The authors have no relevant financial or nonfinancial interests to disclose.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was funded by Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-009A).