The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs.
Methods:
MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023. Two independent reviewers conducted a systematic review of the literature to select all types of analytic studies comparing robotic versus laparoscopic surgery for GISTs and reporting intraoperative, postoperative, and/or pathological outcomes.
Results:
Overall, 4 retrospective studies were selected, including a total of 264 patients, specifically 111 (42%) in the robotic and 153 (58%) in the laparoscopic group. Robotic surgery was associated with longer operating time (+42.46 min; 95% confidence interval [CI]: 9.34, 75.58; P=0.01; I2: 85%) and reduced use of mechanical staplers (odds ratio [OR]: 0.05; 95%CI: 0.02, 0.11; P<0.00001; I2: 92%;) compared with laparoscopy. Although nonsignificant, conversion to open surgery was less frequently reported for robotic surgery (2.7%) than laparoscopy (5.2%) (OR: 0.59; 95%CI: 0.17, 2.03; P=0.4; I2: 0%). No difference was found for postoperative and oncological outcomes.
Conclusions:
Robotic surgery for gastric GISTs provides similar intraoperative, postoperative, and pathological outcomes to laparoscopy, despite longer operative time.
Get full access to this article
View all access options for this article.
References
1.
JoensuuH, VehtariA, RiihimakiJ, et al.Risk of recurrence of gastrointestinal stromal tumour after surgery: An analysis of pooled population-based cohorts. Lancet Oncol, 2012; 13(3):265–274.
2.
FletcherCD, BermanJJ, CorlessC, et al.Diagnosis of gastrointestinal stromal tumors: A consensus approach. Int J Surg Pathol, 2002; 10(2):81–89.
3.
RautCP, MorganJA, AshleySW. Current issues in gastrointestinal stromal tumors: Incidence, molecular biology, and contemporary treatment of localized and advanced disease. Curr Opin Gastroenterol, 2007; 23(2):149–158.
4.
DeMatteoRP, LewisJJ, LeungD, et al.Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Ann Surg, 2000; 231(1):51–58.
5.
MiettinenM, LasotaJ. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch, 2001; 438(1):1–12.
KawanowaK, SakumaY, SakuraiS, et al.High incidence of microscopic gastrointestinal stromal tumors in the stomach. Hum Pathol, 2006; 37(12):1527–1535.
8.
BiascoG, VeloD, AngrimanI, et al.Gastrointestinal stromal tumors: Report of an audit and review of the literature. Eur J Cancer Prev, 2009; 18(2):106–116.
9.
IshidaT, TakahashiT, KurokawaY, et al.Targeted therapy for drug-tolerant persister cells after imatinib treatment for gastrointestinal stromal tumours. Br J Cancer, 2021; 125(11):1511–1522.
10.
JakhetiyaA, GargPK, PrakashG, et al.Targeted therapy of gastrointestinal stromal tumours. World J Gastrointest Surg, 2016; 8(5):345–352.
11.
HeinrichMC, CorlessCL. Gastric GI stromal tumors (GISTs): The role of surgery in the era of targeted therapy. J Surg Oncol, 2005; 90(3):195–207;discussion.
12.
CasaliPG, AbecassisN, AroHT, et al.ESMO Guidelines Committee and EURACAN. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2018; 29(Suppl 4):iv267.
13.
LukaszczykJJ, PreletzRJJr., Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg, 1992; 2(6):331–334.
14.
LiaoGQ, ChenT, QiXL, et al.Laparoscopic management of gastric gastrointestinal stromal tumors: A retrospective 10-year single-center experience. World J Gastroenterol, 2017; 23(19):3522–3529.
15.
De VogelaereK, Van LooI, PetersO, et al.Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc, 2012; 26(8):2339–2345.
16.
BedardEL, MamazzaJ, SchlachtaCM, et al.Laparoscopic resection of gastrointestinal stromal tumors: Not all tumors are created equal. Surg Endosc, 2006; 20(3):500–503.
17.
ChoiSM, KimMC, JungGJ, et al.Laparoscopic wedge resection for gastric GIST: Long-term follow-up results. Eur J Surg Oncol, 2007; 33(4):444–447.
18.
LaiIR, LeeWJ, YuSC. Minimally invasive surgery for gastric stromal cell tumors: Intermediate follow-up results. J Gastrointest Surg, 2006; 10(4):563–566.
19.
NovitskyYW, KercherKW, SingRF, et al.Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg, 2006; 243(6):738–745. discussion 45-7.
20.
RosaF, RicciR, GaliandroF, et al.Laparoscopic vs. open resection of gastrointestinal stromal tumors (GISTs) from gastric origin: Different approaches for different diseases. Minerva Surg, 2021; 76(4):372–381.
21.
LianX, FengF, GuoM, et al.Meta-analysis comparing laparoscopic versus open resection for gastric gastrointestinal stromal tumors larger than 5 cm. BMC Cancer, 2017; 17(1):760.
22.
KarakousisGC, SingerS, ZhengJ, et al.Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): A size-matched comparison. Ann Surg Oncol, 2011; 18(6):1599–1605.
23.
YeX, KangWM, YuJC, et al.Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors. World J Gastroenterol, 2017; 23(25):4595–4603.
24.
ZhengL, DingW, ZhouD, et al.Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: A meta-analysis. Am Surg, 2014; 80(1):48–56.
25.
de’AngelisN, BrunettiF, FelliE, et al.Laparoscopic versus open gastric wedge resection for primary gastrointestinal tumors: Clinical outcomes and health care costs analysis. Surg Laparosc Endosc Percutan Tech, 2015; 25(2):143–146.
26.
SheetzKH, ClaflinJ, DimickJB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open, 2020; 3(1):e1918911.
27.
MarchegianiF, SiragusaL, ZadoroznyjA, et al.New robotic platforms in general surgery: What’s the current clinical scenario? Medicina (Kaunas), 2023; 59(7)
28.
RosaF, SchenaCA, LaterzaV, et al.The role of surgery in the management of gastric cancer: State of the art. Cancers (Basel), 2022; 14(22)
29.
SpinoglioG. Robotic surgery: Current applications and new trends. Springer;. 2015.
30.
CeccarelliG, CostaG, De RosaM, et al.Minimally Invasive Approach to Gastric GISTs: Analysis of a multicenter robotic and laparoscopic experience with literature review. Cancers (Basel), 2021; 13(17)
31.
Al-ThaniH, El-MenyarA, MekkodathilA, et al.Robotic management of gastric stromal tumors (GIST): A single Middle Eastern center experience. Int J Med Robot, 2017; 13(1)
32.
ArseneauxM, YarbroughD, NagamotoT. Robotic-assisted free-handed, full-thickness gastric GIST resection with primary repair in unfavorable locations. J Robot Surg, 2019; 13(3):491–494.
33.
BuchsNC, BucherP, PuginF, et al.Robot-assisted oncologic resection for large gastric gastrointestinal stromal tumor: A preliminary case series. J Laparoendosc Adv Surg Tech A, 2010; 20(5):411–415.
34.
DesiderioJ, TrastulliS, CirocchiR, et al.Robotic gastric resection of large gastrointestinal stromal tumors. Int J Surg, 2013; 11(2):191–196.
35.
FurbettaN, PalmeriM, GuadagniS, et al.Gastrointestinal stromal tumours of stomach: Robot-assisted excision with the da Vinci Surgical System regardless of size and location site. J Minim Access Surg, 2019; 15(2):142–147.
36.
MoriyamaH, IshikawaN, KawaguchiM, et al.Robot-assisted laparoscopic resection for gastric gastrointestinal stromal tumor. Surg Laparosc Endosc Percutan Tech, 2012; 22(3):e155-6–e156.
37.
VicenteE, QuijanoY, IelpoB, et al.Robot-assisted resection of gastrointestinal stromal tumors (GIST): A single center case series and literature review. Int J Med Robot, 2016; 12(4):718–723.
38.
ZhaoJ, WangG, JiangZ, et al.Robotic gastrotomy with intracorporeal suture for patients with gastric gastrointestinal stromal tumors located at cardia and subcardiac region. Surg Laparosc Endosc Percutan Tech, 2018; 28(1):e1–e7.
39.
de’AngelisN, GenovaP, AmiotA, et al.Robotic versus laparoscopic gastric resection for primary gastrointestinal stromal tumors >5 cm: A size-matched and location-matched comparison. Surg Laparosc Endosc Percutan Tech, 2017; 27(1):65–71.
40.
ShiF, LiuG, SunQ, et al.Clinical outcomes and functional analysis of third space robotic and endoscopic cooperative surgery versus laparoscopic wedge resection for gastric submucosal tumours: A Propensity Score-Matched Study. Updates Surg, 2022; 74(2):685–695.
41.
SolainiL, CavaliereD, FicoV, et al.Open versus laparoscopic versus robotic gastric gastrointestinal stromal tumour resections: A Multicentre Cohort Study. Int J Med Robot, 2021; 17(2):e2198.
42.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021; 372:n71.
43.
StangA. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010; 25(9):603–605.
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.
46.
CumpstonM, LiT, PageMJ, et al.Updated guidance for trusted systematic reviews: A new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev, 2019; 10(10):ED000142.
47.
HigginsJP, AltmanDG, GotzschePC, et al.The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011; 343:d5928.
48.
HigginsJP, ThompsonSG, DeeksJJ, et al.Measuring inconsistency in meta-analyses. BMJ, 2003; 327(7414):557–560.
49.
YoshidaM, OtaniY, OhgamiM, et al.Surgical management of gastric leiomyosarcoma: Evaluation of the propriety of laparoscopic wedge resection. World J Surg, 1997; 21(4):440–443.
50.
KalinowskaI, ZdzienickiM, SkoczylasJ, et al.A narrative review of surgical management of gastrointestinal stromal tumors. Gastrointest Stromal Tumor, 2021; 4:5–5.
ZhengGL, ZhangB, WangY, et al.Surgical resection of esophagogastric junction stromal tumor: How to protect the cardiac function. World J Gastroenterol, 2021; 27(9):854–865.
53.
ZhangH, LiuX, ZhengZ, et al.Safety, efficacy, and selection strategy of laparoscopic local gastrectomy for gastrointestinal stromal tumors in the esophagogastric junction. Front Surg, 2022; 9:1015126.
54.
CasaliPG, BlayJY, AbecassisN, et al.Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2022; 33(1):20–33.
RaceA, HorganS. Overview of current robotic technology. In: HorganS, FuchsK-H., editors. Innovative Endoscopic and Surgical Technology in the GI Tract. Springer International Publishing.: Cham; 2021. p. 1–17.
57.
Leal GhezziT, Campos CorletaO. 30 Years of Robotic Surgery. World J Surg, 2016; 40(10):2550–2557.
58.
CorcioneF, EspositoC, CuccurulloD, et al.Advantages and limits of robot-assisted laparoscopic surgery: Preliminary experience. Surg Endosc, 2005; 19(1):117–119.
59.
YohannesP, RotariuP, PintoP, et al.Comparison of robotic versus laparoscopic skills: Is there a difference in the learning curve? Urology, 2002; 60(1):39–45; discussion.
60.
LiuN, GreenbergJA. Robotics vs laparoscopy-are they truly rivals? JAMA Surg, 2020; 155(5):388.
61.
KimHJ, ChoiGS, ParkJS, et al.Comparison of surgical skills in laparoscopic and robotic tasks between experienced surgeons and novices in laparoscopic surgery: An experimental study. Ann Coloproctol, 2014; 30(2):71–76.
62.
BianchiG, GavriilidisP, Martinez-PerezA, et al.Robotic multiquadrant colorectal procedures: A single-center experience and a systematic review of the literature. Front Surg, 2022; 9:991704.
63.
WeeIJY, KuoLJ, NguJC. A systematic review of the true benefit of robotic surgery: Ergonomics. Int J Med Robot, 2020; 16(4):e2113.
64.
NgKT, TsiaAKV, ChongVYL. Robotic versus conventional laparoscopic surgery for colorectal cancer: A systematic review and meta-analysis with trial sequential analysis. World j Surg, 2019; 43(4):1146–1161.
65.
RahimliM, PerrakisA, AndricM, et al.Does robotic liver surgery enhance r0 results in liver malignancies during minimally invasive liver surgery?-a systematic review and meta-analysis. Cancers (Basel), 2022; 14(14)
66.
KamarajahSK, SutandiN, RobinsonSR, et al.Robotic versus conventional laparoscopic distal pancreatic resection: a systematic review and meta-analysis. HPB (Oxford), 2019; 21(9):1107–1118.
67.
de’AngelisN, SchenaCA, MoszkowiczD, et al.Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis. Surg Endosc, 2023; 38(1):24–46.
68.
MaranoA, ChoiYY, HyungWJ, et al.Robotic versus laparoscopic versus open gastrectomy: A Meta-Analysis. J Gastric Cancer, 2013; 13(3):136–148.
69.
GuerriniGP, EspositoG, MagistriP, et al.Robotic versus laparoscopic gastrectomy for gastric cancer: The largest meta-analysis. Int J Surg, 2020; 82:210–228.
70.
NgAP, SanaihaY, BakhtiyarSS, et al.National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations. Surgery, 2023; 173(6):1340–1345.
