Robot Versus Laparoscopic Gastrectomy for Cancer by an Experienced Surgeon: Comparisons of Surgery, Complications, and Surgical Stress

Background No previous robotic studies present an equivalent surgical quality comparison in an experienced setting for gastric cancer. In addition, a reliable postoperative complication assessment is needed to accurately evaluate surgical outcomes. Methods After 20 cases of robotic-assisted gastrect...

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Bibliographic Details
Published in:Annals of surgical oncology 2013-04, Vol.20 (4), p.1258-1265
Main Authors: Hyun, Myung-Han, Lee, Chung-Ho, Kwon, Ye-Ji, Cho, Sung-Il, Jang, You-Jin, Kim, Dong-Hoon, Kim, Jong-Han, Park, Seong-Heum, Mok, Young-Jae, Park, Sung-Soo
Format: Article
Language:English
Subjects:
Body Mass Index
Female
Follow-Up Studies
Gastrectomy - adverse effects
Gastrointestinal Oncology
Granulocytes - pathology
Humans
Laparoscopy - adverse effects
Length of Stay
Lymph Node Excision
Lymphocytes - pathology
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Obesity
Oncology
Physicians
Postoperative Complications
Prognosis
Prospective Studies
Retrospective Studies
Robotics
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
Survival Rate
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Summary:Background No previous robotic studies present an equivalent surgical quality comparison in an experienced setting for gastric cancer. In addition, a reliable postoperative complication assessment is needed to accurately evaluate surgical outcomes. Methods After 20 cases of robotic-assisted gastrectomy (RAG), a total of 121 consecutive gastric cancer patients underwent gastrectomy (38 RAG vs 83 laparoscopic-assisted gastrectomy [LAG]) from February 2009 to November 2010 at the Department of Surgery, Korea University Anam Hospital, Seoul, Korea. The Clavien-Dindo (C-D) classification was used to classify surgical complications. The granulocyte-to-lymphocyte (G:L) ratio was analyzed to evaluate surgical stress. Results The baseline characteristics, with the exception of age, were similar. The mean total operation time for RAG (234.4 ± 48.0 min) was not significantly different than that for LAG (220.0 ± 60.6 min; P  = 0.198). However, in obese patients, fewer lymph nodes were harvested by RAG (23.4 ± 7.0) than by LAG (32.2 ± 12.5, P  = 0.006). Overall C-D complications were more common for RAG (47.3 vs 38.5 %), but the difference was not significant ( P  = 0.361). The mean hospital stay was similar for the 2 groups. Surgical stress as estimated by the G:L ratio was comparable between the 2 groups. Conclusions RAG performed by an experienced surgeon resulted in similar postoperative outcomes and complications to those of LAG. Assessment of operation time, C-D complication grade, and G:L ratio revealed that RAG is a practical and feasible alternative to LAG, with the possible exception of obese patients.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-012-2679-6