Recent reports have suggested that the use of the robot might reduce the rate of pancreatic complications following minimally invasive radical gastrectomy.
Methods:
By meta-analyzing the available literature, we aimed to elucidate possible differences between conventional laparoscopic and robotic radical gastrectomy on pancreatic morbidity.
Results:
More than 2000 patients from eight studies were eventually included in the analysis. The overall incidence of postoperative pancreatic complications was 2.2%, being 1.7% and 2.5% following robotic and laparoscopic gastrectomy (LG), respectively. In particular, pancreatic fistula occurred in 2.7% of patients receiving robotic gastrectomy (RG) and 3.8% of patients receiving laparoscopy.
Conclusions:
The use of the robot showed a trend toward better outcomes compared with laparoscopy, despite the presence of more advanced disease and higher body mass index. The meta-analysis resulted in an odd ratio of 0.8 favoring RG over LG on pancreatic morbidity, although without statistical significance.
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References
1.
HuangJ, QianL. The study on the efficacy of fibrin glue in preventing post-traumatic focal pancreatitis (PTFP) after radical gastrectomy. J Gastrointest Surg, 2014; 18:476–480.
2.
HerbellaFA, TineliAC, WilsonJLJr, Del GrandeJC. Gastrectomy and lymphadenectomy for gastric cancer: Is the pancreas safe?. J Gastrointest Surg, 2008; 12:1912–1914.
3.
GuerraF, GiulianiG, IacoboneM, BianchiPP, CorattiA. Pancreas-related complications following gastrectomy: Systematic review and meta-analysis of open versus minimally invasive surgery. Surg Endosc, 2017; 31:4346–4356.
4.
ObamaK, OkabeH, HosogiH, TanakaE, ItamiA, SakaiY. Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: From a viewpoint of pancreas-related complications. Surgery, 2011; 149:15.
5.
KobayashiD, IwataN, TanakaC, KandaM, YamadaS, NakayamaG, FujiiT, KoikeM, FujiwaraM, KoderaY. Factors related to occurrence and aggravation of pancreatic fistula after radical gastrectomy for gastric cancer. J Surg Oncol, 2015; 112:381–386.
6.
KomatsuS, IchikawaD, KashimotoK, KubotaT, OkamotoK, KonishiH, ShiozakiA, FujiwaraH, OtsujiE. Risk factors to predict severe postoperative pancreatic fistula following gastrectomy for gastric cancer. World J Gastroenterol, 2013; 19:8696–8702.
7.
SudaK, NakauchiM, InabaK, IshidaY, UyamaI. Revising robotic surgery for stomach, potential benefits revised II: Prevention of pancreatic fistula. Transl Gastrointest Cancer, 2015; 4:461–467.
8.
SudaK, NakauchiM, InabaK, IshidaY, UyamaI. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature. World J Gastroenterol, 2016; 22:4626–4637.
9.
HikiN, HondaM, EtohT, YoshidaK, KoderaY, KakejiY, KumamaruH, MiyataH, YamashitaY, InomataM, KonnoH, SetoY, KitanoS. Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer, 2018; 21:162–170.
10.
TsujiuraM, HikiN, OhashiM, NunobeS, KumagaiK, IdaS, OkumuraY, SanoT, YamaguchiT. “Pancreas-Compressionless Gastrectomy”: A novel laparoscopic approach for suprapancreatic lymph node dissection. Ann Surg Oncol, 2017; 24:3331–3337.
11.
MatsunagaT, SaitoH, MurakamiY, KurodaH, FukumotoY, OsakiT. Usefulness of T-shaped gauze for precise dissection of supra-pancreatic lymph nodes and for reduced postoperative pancreatic fistula in patients undergoing laparoscopic gastrectomy for gastric cancer. Yonago Acta Med, 2016; 59:232–236.
12.
MigitaK, MatsumotoS, WakatsukiK, ItoM, KunishigeT, NakadeH, NakataniM, KitanoM, NakajimaY. The anatomical location of the pancreas is associated with the incidence of pancreatic fistula after laparoscopic gastrectomy. Surg Endosc, 2016; 30:5481–5489.
13.
ViñuelaEF, GonenM, BrennanMF, CoitDG, StrongVE. Laparoscopic versus open distal gastrectomy for gastric cancer: A meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg, 2012; 255:446–456.
14.
KimW, KimHH, HanSU, KimMC, HyungWJ, RyuSW, ChoGS, KimCY, YangHK, ParkDJ, SongKY, LeeSI, RyuSY, LeeJH, LeeHJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: Short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg, 2016; 263:28–35.
15.
ParkYK, YoonHM, KimYW, ParkJY, RyuKW, LeeYJ, JeongO, YoonKY, LeeJH, LeeSE, YuW, JeongSH, KimT, KimS, Nam BHCOACT group. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: Results from a randomized phase II multicenter clinical trial (COACT 1001). Ann Surg, 2018; 267:638–645.
16.
FujitaT, OhtaM, OzakiY, TakahashiY, MiyazakiS, HaradaT, IinoI, KikuchiH, HiramatsuY, KamiyaK, KonnoH. Collateral thermal damage to the pancreas by ultrasonic instruments during lymph node dissection in laparoscopic gastrectomy. Asian J Endosc Surg, 2015; 8:281–288.
17.
ObamaK, KimYM, KangDR, SonT, KimHI, NohSH, HyungWJ. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer, 2018; 21:285–295.
18.
JiangX, HikiN, NunobeS, et al.Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer. Ann Surg Oncol, 2012; 19:115.
19.
KobayashiN, ShinoharaH, HarutaS, OhkuraY, MizunoA, UenoM, UdagawaH, SakaiY. Process of pancreas head as a risk factor for postoperative pancreatic fistula in laparoscopic gastric cancer surgery. World J Surg, 2016; 40:2194–2201.
20.
NakauchiM, SudaK, SusumuS, KadoyaS, InabaK, IshidaY, UyamaI. 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; 30:5444–5452.
NoshiroH, IkedaO, UrataM. Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone. Surg Endosc, 2014; 28:1180–1187.
23.
LiberatiA, AltmanDG, TetzlaffJ, MulrowC, GøtzschePC, IoannidisJP, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ, 2009; 339:b2700.
24.
StroupDF, BerlinJA, MortonSC, et al.Meta-analysis of observational studies in epidemiology. JAMA, 2000; 283:2008–2012.
25.
Cochrane Handbook for Systematic Reviews of Interventions Higgins JPT, GreenS (eds). Version 5.1.0 [updated March 2011]. London: The Cochrane Collaboration, 2011.
26.
HozoSP, DjulbegovicB, HozoI. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005; 5:13.
27.
CarusoS, PatritiA, RovielloF, De FrancoL, FranceschiniF, CorattiA, CeccarelliG. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations. World J Gastroenterol, 2016; 22:5694–5717.
28.
CarusoS, PatritiA, RovielloF, De FrancoL, FranceschiniF, CeccarelliG, CorattiA. Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis. World J Clin Oncol, 2017; 8:273–284.
29.
CarusoS, FranceschiniF, PatritiA, RovielloF, AnnecchiaricoM, CeccarelliG, CorattiA. Robot-assisted laparoscopic gastrectomy for gastric cancer. World J Gastrointest Endosc, 2017; 9:1–11.
ChenK, PanY, ZhangB, MaherH, WangXF, CaiXJ. Robotic versus laparoscopic Gastrectomy for gastric cancer: A systematic review and updated meta-analysis. BMC Surg, 2017; 17:93.
32.
ClarkJ, SodergrenMH, PurkayasthaS, MayerEK, JamesD, AthanasiouT, YangGZ, DarziA. The role of robotic assisted laparoscopy for oesophagogastric oncological resection; an appraisal of the literature. Dis Esophagus, 2011; 24:240–250.
33.
CorattiA, AnnecchiaricoM, Di MarinoM, GentileE, CorattiF, GiulianottiPC. Robot-assisted gastrectomy for gastric cancer: Current status and technical considerations. World J Surg, 2013; 37:2771–2781.
34.
EomBW, YoonHM, RyuKW, LeeJH, ChoSJ, LeeJY, KimCG, ChoiIJ, LeeJS, KookMC, RheeJY, ParkSR, KimYW. Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol, 2012; 38:57–63.
35.
HanDS, SuhYS, AhnHS, KongSH, LeeHJ, KimWH, YangHK. Comparison of surgical outcomes of robot-assisted and laparoscopy-assisted pylorus-preserving gastrectomy for gastric cancer: A propensity score matching analysis. Ann Surg Oncol, 2015; 22:2323–2328.
36.
HuangKH, LanYT, FangWL, ChenJH, LoSS, HsiehMC, LiAF, ChiouSH, WuCW. Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg, 2012; 16:1303–1310.
37.
HuangKH, LanYT, FangWL, ChenJH, LoSS, LiAF, ChiouSH, WuCW, ShyrYM. Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS One, 2014; 9:e111499.
38.
HyunMH, LeeCH, KwonYJ, ChoSI, JangYJ, KimDH, KimJH, ParkSH, MokYJ, ParkSS. Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: Comparisons of surgery, complications, and surgical stress. Ann Surg Oncol, 2013; 20:1258–1265.
39.
IsogakiJ, HarutaS, Man-IM, SudaK, KawamuraY, YoshimuraF, KawabataT, InabaK, IshikawaK, IshidaY, TaniguchiK, SatoS, KanayaS, UyamaI. Robot-assisted surgery for gastric cancer: Experience at our institute. Pathobiology, 2011; 78:328–333.
40.
KangBH, XuanY, HurH, AhnCW, ChoYK, HanSU. Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: The learning curve of robotic surgery. J Gastric Cancer, 2012; 12:156–163.
41.
KimHI, ParkMS, SongKJ, WooY, HyungWJ. Rapid and safe learning of robotic gastrectomy for gastric cancer: Multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg Oncol, 2014; 40:1346–1354.
42.
KimHI, HanSU, YangHK, KimYW, LeeHJ, RyuKW, ParkJM, AnJY, KimMC, ParkS, SongKY, OhSJ, KongSH, SuhBJ, YangDH, HaTK, KimYN, HyungWJ. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg, 2016; 263:103–109.
43.
KimYW, ReimD, ParkJY, EomBW, KookMC, RyuKW, YoonHM. Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc, 2016; 30:1547–1552.
44.
KimMC, HeoGU, JungGJ. Robotic gastrectomy for gastric cancer: Surgical techniques and clinical merits. Surg Endosc, 2010; 24:610–615.
45.
KimKM, AnJY, KimHI, CheongJH, HyungWJ, NohSH. Major early complications following open, laparoscopic and robotic gastrectomy. Br J Surg, 2012; 99:1681–1687.
46.
JunfengZ, YanS, BoT, YingxueH, DongzhuZ, YongliangZ, FengQ, PeiwuY. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: Comparison of surgical performance and short-term outcomes. Surg Endosc, 2014; 28:1779–1787.
47.
LeeJ, KimYM, WooY, ObamaK, NohSH, HyungWJ. 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, 2015; 29:3251–3260.
48.
LeeS, SonT, KimHI, HyungWJ. Status and prospects of robotic gastrectomy for gastric cancer: Our experience and a review of the literature. Gastroenterol Res Pract, 2017; 2017:7197652.
49.
LiuCA, HuangKH, ChenMH, LoSS, LiAF, WuCW, ShyrYM, FangWL. Comparison of the surgical outcomes of minimally invasive and open surgery for octogenarian and older compared to younger gastric cancer patients: A retrospective cohort study. BMC Surg, 2017; 17:68.
50.
MaranoA, ChoiYY, HyungWJ, KimYM, KimJ, NohSH. Robotic versus laparoscopic versus open gastrectomy: A meta-analysis. J Gastric Cancer, 2013; 13:136–148.
51.
OkumuraN, SonT, KimYM, KimHI, AnJY, NohSH, HyungWJ. Robotic gastrectomy for elderly gastric cancer patients: Comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly. Gastric Cancer, 2016; 19:1125–1134.
52.
PanJH, ZhouH, ZhaoXX, DingH, QinL, PanYL. Long-term oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: A meta-analysis. Surg Endosc, 2017; 31:4244–4251.
53.
ParisiA, ReimD, BorghiF, NguyenNT, QiF, CorattiA, CianchiF, CesariM, BazzocchiF, AlimogluO, GagnièreJ, PernazzaG, D'ImporzanoS, ZhouYB, AzagraJS, FacyO, BrowerST, JiangZW, ZangL, IsikA, GeminiA, TrastulliS, NovotnyA, MaranoA, LiuT, AnnecchiaricoM, BadiiB, ArcuriG, AvanzoliniA, LeblebiciM, PezetD, CaoSG, GoergenM, ZhangS, PalazziniG, D'AndreaV, DesiderioJ. Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery. World J Gastroenterol, 2017; 23:2376–2384.
54.
ParkJM, KimHI, HanSU, YangHK, KimYW, LeeHJ, AnJY, KimMC, ParkS, SongKY, OhSJ, KongSH, SuhBJ, YangDH, HaTK, HyungWJ, RyuKW. Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy. Eur J Surg Oncol, 2016; 42:1944–1949.
55.
ParkJY, RyuKW, ReimD, EomBW, YoonHM, RhoJY, ChoiIJ, KimYW. Robot-assisted gastrectomy for early gastric cancer: Is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy?. World J Surg, 2015; 39:1789–1797.
56.
ParkJY, JoMJ, NamBH, KimY, EomBW, YoonHM, RyuKW, KimYW, LeeJH. Surgical stress after robot-assisted distal gastrectomy and its economic implications. Br J Surg, 2012; 99:1554–1561.
57.
PuglieseR, MaggioniD, SansonnaF, CostanziA, FerrariGC, Di LerniaS, MagistroC, De MartiniP, PuglieseF. Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: Results and 5-year survival. Surg Endosc, 2010; 24:2594–2602.
58.
PuglieseR, MaggioniD, SansonnaF, FerrariGC, ForgioneA, CostanziA, MagistroC, PaunaJ, Di LerniaS, CitterioD, BrambillaC. Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol, 2009; 35:281–288.
59.
QuijanoY, VicenteE, IelpoB, DuranH, DiazE, FabraI, MalaveL, FerriV, FerronettiA, PlazaC, D'AndreaV, CarusoR. Full robot-assisted gastrectomy: Surgical technique and preliminary experience from a single center. J Robot Surg, 2016; 10:297–306.
60.
ShenW, XiH, WeiB, CuiJ, BianS, ZhangK, WangN, HuangX, ChenL. Robotic versus laparoscopic gastrectomy for gastric cancer: Comparison of short-term surgical outcomes. Surg Endosc, 2016; 30:574–580.
61.
ShenWS, XiHQ, ChenL, WeiB. A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc, 2014; 28:2795–2802.
62.
SonT, LeeJH, KimYM, KimHI, NohSH, HyungWJ. Robotic spleen-preserving total gastrectomy for gastric cancer: Comparison with conventional laparoscopic procedure. Surg Endosc, 2014; 28:2606–2615.
63.
SongJ, KangWH, OhSJ, HyungWJ, ChoiSH, NohSH. Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: Initial experience of 20 consecutive cases. Surg Endosc, 2009; 23:1204–1211.
64.
SudaK, Man-IM, IshidaY, KawamuraY, SatohS, UyamaI. 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; 29:673–685.
65.
SudaK, NakauchiM, InabaK, IshidaY, UyamaI. Robotic surgery for upper gastrointestinal cancer: Current status and future perspectives. Dig Endosc, 2016; 28:701–713.
66.
TsaiSH, LiuCA, HuangKH, LanYT, ChenMH, ChaoY, LoSS, LiAF, WuCW, ChiouSH, YangMH, ShyrYM, FangWL. Advances in laparoscopic and robotic gastrectomy for gastric cancer. Pathol Oncol Res, 2017; 23:13–17.
67.
UyamaI, KanayaS, IshidaY, InabaK, SudaK, SatohS. Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: Technique and initial experience. World J Surg, 2012; 36:331–337.
68.
YangSY, RohKH, KimYN, ChoM, LimSH, SonT, HyungWJ, KimHI. Surgical outcomes after open, laparoscopic, and robotic gastrectomy for gastric cancer. Ann Surg Oncol, 2017; 24:1770–1777.
69.
YoonHM, KimYW, LeeJH, RyuKW, EomBW, ParkJY, ChoiIJ, KimCG, LeeJY, ChoSJ, RhoJY. Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc, 2012; 26:1377–1381.
70.
YouYH, KimYM, AhnDH. Beginner surgeon's initial experience with distal subtotal gastrectomy for gastric cancer using a minimally invasive approach. J Gastric Cancer, 2015; 15:270–277.
71.
XiongB, MaL, ZhangC. Robotic versus laparoscopic gastrectomy for gastric cancer: A meta-analysis of short outcomes. Surg Oncol, 2012; 21:274–280.
72.
WangG, JiangZ, ZhaoJ, LiuJ, ZhangS, ZhaoK, FengX, LiJ. 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.
73.
WooY, HyungWJ, PakKH, InabaK, ObamaK, ChoiSH, NohSH. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg, 2011; 146:1086–1092.
74.
MiyaiH, HaraM, HayakawaT, TakeyamaH. Establishment of a simple predictive scoring system for pancreatic fistula after laparoscopy-assisted gastrectomy. Dig Endosc, 2013; 25:585–592.
75.
MikiY, TokunagaM, BandoE, TanizawaY, KawamuraT, TerashimaM. Evaluation of postoperative pancreatic fistula after total gastrectomy with D2 lymphadenectomy by ISGPF classification. J Gastrointest Surg, 2011; 15:1969–1976.
76.
CarusoS, PatritiA, MarrelliD, CeccarelliG, CeribelliC, RovielloF, CasciolaL. Open vs robot-assisted laparoscopic gastric resection with D2 lymph node dissection for adenocarcinoma: A case-control study. Int J Med Robot, 2011; 7:452–458.
77.
ProcopiucL, TudorS, ManucM, DiculescuM, VasilescuC. Open vs robotic radical gastrectomy for locally advanced gastric cancer. Int J Med Robot, 2016; 12:502–508.
78.
BassiC, MarchegianiG, DervenisC, SarrM, Abu HilalM, AdhamM, AllenP, AnderssonR, AsbunHJ, BesselinkMG, ConlonK, Del ChiaroM, FalconiM, Fernandez-CruzL, Fernandez-Del CastilloC, FingerhutA, FriessH, GoumaDJ, HackertT, IzbickiJ, LillemoeKD, NeoptolemosJP, OlahA, SchulickR, ShrikhandeSV, TakadaT, TakaoriK, TraversoW, VollmerCR, WolfgangCL, YeoCJ, SalviaR, BuchlerM, International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017; 161:584–591.
79.
CorattiA, FernandesE, LombardiA, Di MarinoM, AnnecchiaricoM, FelicioniL, GiulianottiPC. 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; 41:1106–1113.
de SteurWO, HartgrinkHH, DikkenJL, PutterH, van de VeldeCJ. Quality control of lymph node dissection in the Dutch Gastric Cancer Trial. Br J Surg, 2015; 102:1388–1393.
82.
SongunI, PutterH, KranenbargEM, SasakoM, van de VeldeCJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol, 2010; 11:439–449.
83.
KungCH, LindbladM, NilssonM, RouvelasI, KumagaiK, LundellL, TsaiJA. Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients. Gastric Cancer, 2014; 17:571–577.
84.
BoT, ZhihongP, PeiwuY, FengQ, ZiqiangW, YanS, YongliangZ, HuaxinL. General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them. Surg Endosc, 2009; 23:1860–1865.
