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Clinical efficacy and safety of robotic distal gastrectomy for gastric cancer: a systematic review and meta-analysis.

Shiyi Gong, Xiong Li, Hongwei Tian, Shaoming Song, Tingting Lu, Wutang Jing, Xianbin Huang, Yongcheng Xu, Xingqiang Wang, Kaixuan Zhao, Kehu Yang, Tiankang Guo

Journal: Surgical endoscopy 2022;36(5):2734-2748

PMID: 35020057

Full Text on Springer View on PubMed

Abstract

BACKGROUND

Robotic distal gastrectomy (RDG) is a new technique that is rapidly gaining popularity and may help overcome the limitations of laparoscopic distal gastrectomy (LDG); however, its safety and therapeutic efficacy remain controversial. Therefore, this meta-analysis was performed to evaluate the safety and efficacy of RDG.

METHODS

We searched PubMed, EMBASE, the Cochrane Library, and Web of Science for studies that compared RDG and LDG and were published between the time of database inception and May 2021. We assessed the bias risk of the observational studies using ROBIN-I, and a random effect model was always applied.

RESULTS

The meta-analysis included 22 studies involving 5386 patients. Compared with LDG, RDG was associated with longer operating time (Mean Difference [MD] = 43.88, 95% CI = 35.17-52.60), less intraoperative blood loss (MD = - 24.84, 95% CI = - 41.26 to - 8.43), a higher number of retrieved lymph nodes (MD = 2.41, 95% CI = 0.77-4.05), shorter time to first flatus (MD = - 0.09, 95% CI = - 0.15 to - 0.03), shorter postoperative hospital stay (MD = - 0.68, 95% CI = - 1.27 to - 0.08), and lower incidence of pancreatic fistula (OR = 0.23, 95% CI = 0.07-0.79). Mean proximal and distal resection margin distances, time to start liquid and soft diets, and other complications were not significantly different between RDG and LDG groups. However, in the propensity-score-matched meta-analysis, the differences in time to first flatus and postoperative hospital stay between the two groups lost significance.

CONCLUSIONS

Based on the available evidence, RDG appears feasible and safe, shows better surgical and oncological outcomes than LDG and, comparable postoperative recovery and postoperative complication outcomes.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Address: Ningxia Medical University, Yinchuan, 750000, Ningxia, China.; Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 222 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China.; Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 222 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 222 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, China.; Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Ningxia Medical University, Yinchuan, 750000, Ningxia, China.; Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China.; Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China. [email protected].; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 222 West Donggang R.D., Lanzhou, 730000, Gansu, China. [email protected].; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, China. [email protected].; Ningxia Medical University, Yinchuan, 750000, Ningxia, China. [email protected].; Department of General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China. [email protected].; Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China. [email protected].
DOI: 10.1007/s00464-021-08994-x

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MeSH Terms: Flatulence, Gastrectomy, Humans, Laparoscopy, Postoperative Complications, Robotic Surgical Procedures, Stomach Neoplasms, Treatment Outcome
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