Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

  • Marano, Alessandra (Department of Surgery, Yonsei University College of Medicine) ;
  • Choi, Yoon Young (Department of Surgery, Yonsei University College of Medicine) ;
  • Hyung, Woo Jin (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Yoo Min (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Jieun (Biostatistics Collaboration Unit, Yonsei University College of Medicine) ;
  • Noh, Sung Hoon (Department of Surgery, Yonsei University College of Medicine)
  • Received : 2013.07.24
  • Accepted : 2013.08.27
  • Published : 2013.09.30
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Abstract

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Keywords

References

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