DOI QR코드

DOI QR Code

Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: The Learning Curve of Robotic Surgery

  • Kang, Byung Hee (Department of Surgery, Ajou University School of Medicine) ;
  • Xuan, Yi (Department of Surgery, Ajou University School of Medicine) ;
  • Hur, Hoon (Department of Surgery, Ajou University School of Medicine) ;
  • Ahn, Chang Wook (Department of Surgery, Ajou University School of Medicine) ;
  • Cho, Yong Kwan (Department of Surgery, Ajou University School of Medicine) ;
  • Han, Sang-Uk (Department of Surgery, Ajou University School of Medicine)
  • Received : 2012.07.17
  • Accepted : 2012.08.09
  • Published : 2012.09.30

Abstract

Purpose: Laparoscopic gastrectomy is a widely accepted surgical technique. Recently, robotic gastrectomy has been developed, as an alternative minimally invasive surgical technique. This study aimed to evaluate the question of whether robotic gastrectomy is feasible and safe for the treatment of gastric cancer, due to its learning curve. Materials and Methods: We retrospectively reviewed the prospectively collected data of 100 consecutive robotic gastrectomy patients, from November 2008 to March 2011, and compared them to 282 conventional laparoscopy patients during the same period. The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups. Results: The initial 20 robotic gastrectomy cases were defined as the initial group, due to the learning curve. The initial group had a longer average operating time ($242.25{\pm}74.54$ minutes vs. $192.56{\pm}39.56$ minutes, P>0.001), and hospital stay ($14.40{\pm}24.93$ days vs. $8.66{\pm}5.39$ days, P=0.001) than the experienced group. The length of hospital stay was no different between the experienced group, and the laproscopic gastrectomy group ($8.66{\pm}5.39$ days vs. $8.11{\pm}4.10$ days, P=0.001). The average blood loss was significantly less for the robotic gastrectomy groups, than for the laparoscopic gastrectomy group ($93.25{\pm}84.59$ ml vs. $173.45{\pm}145.19$ ml, P<0.001), but the complication rates were no different. Conclusions: Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.

Keywords

References

  1. Shin HR, Jung KW, Won YJ, Kong HJ, Yim SH, Sung J, et al. National cancer incidence for the year 2002 in Korea. Cancer Res Treat 2007;39:139-149. https://doi.org/10.4143/crt.2007.39.4.139
  2. Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, et al. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg 2011;98:255-260. https://doi.org/10.1002/bjs.7310
  3. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, et al; Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a largescale korean multicenter study. Ann Surg Oncol 2008;15:2692-2700. https://doi.org/10.1245/s10434-008-0075-z
  4. Shehzad K, Mohiuddin K, Nizami S, Sharma H, Khan IM, Memon B, et al. Current status of minimal access surgery for gastric cancer. Surg Oncol 2007;16:85-98. https://doi.org/10.1016/j.suronc.2007.04.012
  5. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N; Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007;245:68-72. https://doi.org/10.1097/01.sla.0000225364.03133.f8
  6. Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 2010;24:610-615. https://doi.org/10.1007/s00464-009-0618-9
  7. Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, et al. Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 2001;25:1467-1477.
  8. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg 2004;239:14-21. https://doi.org/10.1097/01.sla.0000103020.19595.7d
  9. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 2009;249:927-932. https://doi.org/10.1097/01.sla.0000351688.64999.73
  10. Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Forgione A, Costanzi A, et al. 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. https://doi.org/10.1016/j.ejso.2008.02.001
  11. Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, et al. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg 2011;146:1086-1092. https://doi.org/10.1001/archsurg.2011.114
  12. Anderson C, Ellenhorn J, Hellan M, Pigazzi A. Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc 2007;21:1662-1666. https://doi.org/10.1007/s00464-007-9266-0
  13. Patriti A, Ceccarelli G, Bellochi R, Bartoli A, Spaziani A, Di Zitti L, et al. Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma. Surg Endosc 2008;22:2753-2760. https://doi.org/10.1007/s00464-008-0129-0
  14. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopyassisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 2005;11:7508-7511.
  15. Jin SH, Kim DY, Kim H, Jeong IH, Kim MW, Cho YK, et al. Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 2007;21:28-33. https://doi.org/10.1007/s00464-005-0634-3
  16. Park SS, Kim MC, Park MS, Hyung WJ. Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc 2012;26:60-67. https://doi.org/10.1007/s00464-011-1828-5
  17. Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH. Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc 2009;23:1204-1211. https://doi.org/10.1007/s00464-009-0351-4
  18. Oh DK, Hur H, Kim JY, Han SU, Cho YK. V-shaped liver retraction during a laparoscopic gastrectomy for gastric cancer. J Gastric Cancer 2010;10:133-136. https://doi.org/10.5230/jgc.2010.10.3.133
  19. Song HM, Lee SL, Hur H, Cho YK, Han SU. Linear-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy. J Gastric Cancer 2010;10:69-74. https://doi.org/10.5230/jgc.2010.10.2.69
  20. Hur H, Kim JY, Cho YK, Han SU. Technical feasibility of robot-sewn anastomosis in robotic surgery for gastric cancer. J Laparoendosc Adv Surg Tech A 2010;20:693-697. https://doi.org/10.1089/lap.2010.0246

Cited by

  1. Comparison of Short-Term Clinical Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Meta-analysis of 2495 Patients vol.23, pp.12, 2013, https://doi.org/10.1089/lap.2013.0279
  2. New treatments for gastric cancer: are they changing clinical practice? vol.10, pp.5, 2012, https://doi.org/10.2217/cpr.13.56
  3. Roboterunterstützte hepatobiliäre Chirurgie und Magenchirurgie vol.84, pp.8, 2012, https://doi.org/10.1007/s00104-013-2581-1
  4. Meta-analysis of Outcomes Compared between Robotic and Laparoscopic Gastrectomy for Gastric Cancer vol.14, pp.8, 2012, https://doi.org/10.7314/apjcp.2013.14.8.4871
  5. Robot-assisted Gastrectomy for Gastric Cancer: Current Status and Technical Considerations vol.37, pp.12, 2012, https://doi.org/10.1007/s00268-013-2100-z
  6. Robotic versus Open Gastrectomy for Gastric Cancer: A Meta-Analysis vol.8, pp.12, 2012, https://doi.org/10.1371/journal.pone.0081946
  7. Emerging Role of Robot-assisted Gastrectomy: Analysis of Consecutive 200 Cases vol.13, pp.4, 2013, https://doi.org/10.5230/jgc.2013.13.4.255
  8. Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited? vol.9, pp.1, 2012, https://doi.org/10.1097/imi.0000000000000039
  9. Pneumatic-type surgical robot end-effector for laparoscopic surgical-operation-by-wire vol.13, pp.None, 2014, https://doi.org/10.1186/1475-925x-13-130
  10. Efficacy Evaluation of Subtotal and Total Gastrectomies in Robotic Surgery for Gastric Cancer Compared with that in Open and Laparoscopic Resections: A Meta-Analysis vol.9, pp.7, 2012, https://doi.org/10.1371/journal.pone.0103312
  11. Spektrum der laparoskopischen Chirurgie bei Magentumoren vol.85, pp.8, 2012, https://doi.org/10.1007/s00104-014-2753-7
  12. Robot‐assisted gastrectomy and oesophagectomy for cancer vol.84, pp.10, 2012, https://doi.org/10.1111/ans.12591
  13. A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer vol.28, pp.10, 2014, https://doi.org/10.1007/s00464-014-3547-1
  14. Meta-analysis of the short-term outcomes of robotic-assisted compared to laparoscopic gastrectomy vol.24, pp.3, 2015, https://doi.org/10.3109/13645706.2014.985685
  15. Robotic gastrectomy for gastric cancer vol.112, pp.3, 2012, https://doi.org/10.1002/jso.23926
  16. Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis : A Novel Approach Adopting the Double-Loop Reconstruction Method vol.94, pp.49, 2012, https://doi.org/10.1097/md.0000000000001922
  17. Comparison of the long-term outcomes of robotic radical gastrectomy for gastric cancer and conventional laparoscopic approach: a single institutional retrospective cohort study vol.30, pp.12, 2012, https://doi.org/10.1007/s00464-016-4904-z
  18. Current status of robotic gastrectomy for gastric cancer vol.46, pp.5, 2016, https://doi.org/10.1007/s00595-015-1190-7
  19. Robotic gastrectomy for elderly gastric cancer patients: comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly vol.19, pp.4, 2012, https://doi.org/10.1007/s10120-015-0560-6
  20. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature vol.22, pp.19, 2016, https://doi.org/10.3748/wjg.v22.i19.4626
  21. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations vol.22, pp.25, 2012, https://doi.org/10.3748/wjg.v22.i25.5694
  22. Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma vol.263, pp.1, 2012, https://doi.org/10.1097/sla.0000000000001249
  23. A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick vol.15, pp.None, 2012, https://doi.org/10.1186/s12938-016-0189-7
  24. Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot‐sewn anastomosis for gastric cancer: A randomized clinical trial vol.113, pp.4, 2012, https://doi.org/10.1002/jso.24146
  25. Robotic surgery for upper gastrointestinal cancer: Current status and future perspectives vol.28, pp.7, 2012, https://doi.org/10.1111/den.12697
  26. Towards standardized robotic surgery in gastrointestinal oncology vol.402, pp.7, 2012, https://doi.org/10.1007/s00423-017-1623-4
  27. Robotic gastrectomy versus open gastrectomy in the treatment of gastric cancer vol.143, pp.1, 2012, https://doi.org/10.1007/s00432-016-2240-2
  28. Robotic Surgery: A Solution in Search of a Problem-A Bayesian Analysis of 343 Robotic Procedures Performed by a Single Surgical Team vol.27, pp.4, 2017, https://doi.org/10.1089/lap.2016.0323
  29. A systematic review and meta-analysis of robot-assisted versus laparoscopically assisted gastrectomy for gastric cancer vol.96, pp.48, 2012, https://doi.org/10.1097/md.0000000000008797
  30. Robotic Verse Laparoscopic Gastrectomy for Gastric Cancer: A Pooled Analysis of 11 Individual Studies vol.27, pp.3, 2012, https://doi.org/10.1097/sle.0000000000000410
  31. Status and Prospects of Robotic Gastrectomy for Gastric Cancer: Our Experience and a Review of the Literature vol.2017, pp.None, 2012, https://doi.org/10.1155/2017/7197652
  32. Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery vol.23, pp.13, 2017, https://doi.org/10.3748/wjg.v23.i13.2376
  33. New totally intracorporeal reconstructive approach after robotic total gastrectomy: Technical details and short-term outcomes vol.23, pp.23, 2012, https://doi.org/10.3748/wjg.v23.i23.4293
  34. Comparison of short outcomes between laparoscopic and experienced robotic gastrectomy: A meta-analysis and systematic review vol.13, pp.1, 2012, https://doi.org/10.4103/0972-9941.182653
  35. Robot-assisted laparoscopic gastrectomy for gastric cancer vol.9, pp.1, 2017, https://doi.org/10.4253/wjge.v9.i1.1
  36. Minimally Invasive Surgery vol.26, pp.2, 2017, https://doi.org/10.1016/j.soc.2016.10.001
  37. Minimally Invasive Surgical Approaches to Gastric Resection vol.97, pp.2, 2012, https://doi.org/10.1016/j.suc.2016.11.003
  38. Robotic gastrectomy for gastric cancer: Current evidence vol.1, pp.2, 2012, https://doi.org/10.1002/ags3.12020
  39. Polish Consensus on Treatment of Gastric Cancer; update 2017 vol.89, pp.5, 2012, https://doi.org/10.5604/01.3001.0010.5413
  40. Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis vol.17, pp.None, 2017, https://doi.org/10.1186/s12893-017-0290-2
  41. Development of stereo endoscope system with its innovative master interface for continuous surgical operation vol.16, pp.None, 2012, https://doi.org/10.1186/s12938-017-0376-1
  42. Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy vol.12, pp.6, 2012, https://doi.org/10.1097/imi.0000000000000437
  43. Comparison of Surgical Outcomes Between Robotic and Laparoscopic Distal Gastrectomy for cT1 Gastric Cancer vol.42, pp.6, 2012, https://doi.org/10.1007/s00268-017-4345-4
  44. Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis vol.10, pp.None, 2012, https://doi.org/10.2147/cmar.s161007
  45. Pancreatic Complications After Conventional Laparoscopic Radical Gastrectomy Versus Robotic Radical Gastrectomy: Systematic Review and Meta-Analysis vol.28, pp.10, 2012, https://doi.org/10.1089/lap.2018.0159
  46. Effectiveness and safety of robotic versus traditional laparoscopic gastrectomy for gastric cancer: An updated systematic review and meta-analysis vol.15, pp.7, 2012, https://doi.org/10.4103/jcrt.jcrt_798_18
  47. Robot-Assisted versus Laparoscopic-Assisted Gastrectomy among Gastric Cancer Patients: A Retrospective Short-Term Analysis from a Single Institution in China vol.2019, pp.None, 2012, https://doi.org/10.1155/2019/9059176
  48. Gastric Cancer Etiology and Management in Asia and the West vol.70, pp.None, 2012, https://doi.org/10.1146/annurev-med-081117-043436
  49. Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study vol.22, pp.2, 2012, https://doi.org/10.1007/s10120-018-00906-8
  50. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies vol.33, pp.4, 2012, https://doi.org/10.1007/s00464-018-06648-z
  51. Robotic Gastric Cancer Surgery: What Happened Last Year? vol.7, pp.7, 2012, https://doi.org/10.1007/s40137-019-0235-z
  52. Robotic-assisted gastrectomy for gastric cancer: a European perspective vol.22, pp.5, 2019, https://doi.org/10.1007/s10120-019-00979-z
  53. Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang's three-step maneuver for advanced upper gastric cancer: Results from a propensity score-match vol.25, pp.37, 2019, https://doi.org/10.3748/wjg.v25.i37.5641
  54. Precision medicine in gastric cancer vol.11, pp.10, 2012, https://doi.org/10.4251/wjgo.v11.i10.804
  55. Robotic-assisted versus conventional laparoscopic-assisted total gastrectomy with D2 lymphadenectomy for advanced gastric cancer: short-term outcomes at a mono-institution vol.19, pp.1, 2012, https://doi.org/10.1186/s12893-019-0549-x
  56. Application of da Vinci robot with the“3 + 2” mode in radical gastrectomy for gastric cancer vol.99, pp.46, 2012, https://doi.org/10.1097/md.0000000000022988
  57. Outcomes of Total and Subtotal Laparoscopic Gastrectomy with D2 Lymphadenectomy in Advanced Gastric Cancer in a Brazilian Hospital vol.11, pp.6, 2012, https://doi.org/10.4236/ss.2020.116019
  58. Lower rate of conversion using robotic-assisted surgery compared to laparoscopy in completion total gastrectomy for remnant gastric cancer vol.34, pp.2, 2012, https://doi.org/10.1007/s00464-019-06838-3
  59. Robotic versus laparoscopic gastrectomy for gastric cancer: protocol for umbrella review of systematic reviews and meta-analyses vol.10, pp.2, 2020, https://doi.org/10.1136/bmjopen-2019-033634
  60. Oncological Robot-Assisted Gastrectomy: Technical Aspects and Ongoing Data vol.30, pp.2, 2012, https://doi.org/10.1089/lap.2019.0345
  61. Minimally invasive gastrectomy for cancer and anastomotic options vol.122, pp.1, 2012, https://doi.org/10.1002/jso.25904
  62. How could we make clinical evidence for early recovery after surgery (ERAS) in minimally invasive surgery for gastric cancer? vol.122, pp.2, 2012, https://doi.org/10.1002/jso.25955
  63. Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer : A Propensity Score-weighted Analysis of 2084 Consecutive Patients vol.274, pp.1, 2021, https://doi.org/10.1097/sla.0000000000003845
  64. Risk Factors for the Severity of Complications in Minimally Invasive Total Gastrectomy for Gastric Cancer: a Retrospective Cohort Study vol.21, pp.None, 2012, https://doi.org/10.5230/jgc.2021.21.e34
  65. Is it Beneficial to Utilize an Articulating Instrument in Single-Port Laparoscopic Gastrectomy? vol.21, pp.1, 2021, https://doi.org/10.5230/jgc.2021.21.e2
  66. Current status of robotic gastrectomy for gastric cancer: comparison with laparoscopic gastrectomy vol.73, pp.3, 2012, https://doi.org/10.1007/s13304-020-00958-5
  67. Robotic gastrointestinal surgery: learning curve, educational programs and outcomes vol.73, pp.3, 2012, https://doi.org/10.1007/s13304-021-00973-0
  68. Incidence and risk factors of postoperative complications after robotic gastrectomy for gastric cancer: an analysis of 817 cases based on 10-year experience in a large-scale center vol.35, pp.12, 2012, https://doi.org/10.1007/s00464-020-08218-8
  69. Establishment of a Fast-Track Gastrectomy Pathway for Patients With Gastric Adenocarcinoma at a U.S. Academic Cancer Center vol.268, pp.None, 2012, https://doi.org/10.1016/j.jss.2021.07.033
  70. Textbook outcome and survival of robotic versus laparoscopic total gastrectomy for gastric cancer: a propensity score matched cohort study vol.11, pp.1, 2012, https://doi.org/10.1038/s41598-021-95017-3