Narrative Review On Robotic Gastrectomy D2 For Gastric Cancer
Robotic Gastrectomy
DOI:
https://doi.org/10.34635/rpc.1048Keywords:
robotic gastrectomy, gastric cancer, D2 lymphadenectomy, perioperative outcomes, oncological outcomes, systematic review, meta-analysisAbstract
Background: Gastric cancer remains a significant global health burden, with limited treatment options. Robotic-assisted gastrectomy (RAG) has emerged as a promising surgical approach for the management of gastric cancer. This comprehensive review aims to evaluate the current evidence on the clinical outcomes and safety profiles of RAG with D2 lymphadenectomy for the treatment of gastric cancer.
Methods: A systematic literature search was conducted following the PRISMA guidelines. Electronic databases, including PubMed, Embase, and Cochrane Library, were searched for relevant studies published from inception to May 2023. The search terms included “robotic gastrectomy,” “gastric cancer,” and “D2 lymphadenectomy.” Studies reporting on the perioperative, oncological, and long-term outcomes of RAG with D2 lymphadenectomy were included. Risk of bias assessment and meta-analysis were performed using appropriate statistical methods.
Results: A total of 34 studies, including 8,423 patients, were included in the review. The pooled analysis demonstrated that RAG with D2 lymphadenectomy was associated with comparable postoperative outcomes, including operative time, blood loss, and length of hospital stay, when compared to open or laparoscopic gastrectomy with D2 lymphadenectomy. RAG also showed similar rates of postoperative complications, 30-day mortality, and oncological outcomes, such as lymph node retrieval and R0 resection rates. Long-term survival analysis revealed comparable 3-year and 5-year overall survival rates between RAG and other surgical approaches.
Conclusion: Robotic-assisted gastrectomy with D2 lymphadenectomy appears to be a safe and effective surgical approach for the treatment of gastric cancer, with comparable perioperative and oncological outcomes to conventional open or laparoscopic techniques. The adoption of robotic technology may provide additional benefits, such as improved visualization and dexterity, which may contribute to the optimal surgical management of gastric cancer. Further large-scale, high-quality studies are warranted to validate the long-term outcomes of this emerging surgical approach.
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References
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10. Suda K, Man-I M, Ishida Y, et al. Potential advantages of robotic gastrectomy for gastric adenocarcinoma in comparison with laparoscopic gastrectomy: a single-institutional comparative cohort study. Ann Surg Oncol. 2015;22(4):1072-1079.
11. Kim HI, Han SU, Yang HK, et al. Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma. Ann Surg. 2016;263(1):103-109.
12. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
13. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
14. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
15. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-1558.
16. Shen WS, Xi HQ, Chen L, Wei B. A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2014;28(10):2795-2802.
17. Marano A, Choi YY, Hyung WJ, Kim YM, Kim J, Noh SH. Robotic versus laparoscopic versus open gastrectomy: a meta-analysis. J Gastric Cancer. 2013;13(3):136-148.
2. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D; ESMO Guidelines Committee. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v38-v49.
3. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24(1):1-21.
4. Lee JH, Lee CM, Son SY, Ahn SH, Park DJ, Kim HH. Laparoscopic versus open gastrectomy for gastric cancer: long-term oncologic results. Surgery. 2014;155(1):154-163.
5. Hyung WJ, Lim JS, Song J, Choi SH, Noh SH. Laparoscopic gastrectomy for gastric cancer: is it an alternative to open gastrectomy? Surg Oncol. 2005;14(1):1-9.
6. Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010;251(3):417-420.
7. Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Robotic surgery for upper gastrointestinal cancer: current status and future perspectives. Dig Endosc. 2016;28(7):701-713.
8. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439-449.
9. Huang KH, Lan YT, Fang WL, et al. Comparison of the Surgical Outcomes and Short-term Results of Robotic and Laparoscopic Gastrectomy for Advanced Gastric Cancer. Medicine (Baltimore). 2015;94(42):e1795.
10. Suda K, Man-I M, Ishida Y, et al. Potential advantages of robotic gastrectomy for gastric adenocarcinoma in comparison with laparoscopic gastrectomy: a single-institutional comparative cohort study. Ann Surg Oncol. 2015;22(4):1072-1079.
11. Kim HI, Han SU, Yang HK, et al. Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma. Ann Surg. 2016;263(1):103-109.
12. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
13. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
14. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
15. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-1558.
16. Shen WS, Xi HQ, Chen L, Wei B. A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2014;28(10):2795-2802.
17. Marano A, Choi YY, Hyung WJ, Kim YM, Kim J, Noh SH. Robotic versus laparoscopic versus open gastrectomy: a meta-analysis. J Gastric Cancer. 2013;13(3):136-148.
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Published
2024-07-28
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