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Hybrid Robotic and Laparoscopic Gastrectomy for Gastric Cancer: Comparison with Conventional Laparoscopic Gastrectomy

  • Kim, So Jung (Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Jeon, Chul Hyo (Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Jung, Yoon Ju (Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Seo, Ho Seok (Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Lee, Han Hong (Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Song, Kyo Young (Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea)
  • Received : 2021.09.04
  • Accepted : 2021.09.29
  • Published : 2021.09.30

Abstract

Purpose: The benefits of robotic gastrectomy remain controversial. We designed this study to elucidate the advantages of a hybrid robot and laparoscopic gastrectomy over conventional laparoscopic surgery. Materials and Methods: A total of 176 patients who underwent gastrectomy for gastric cancer were included in this study. We compared 88 patients treated with hybrid robotic and laparoscopic gastrectomy (HRLG) and 88 patients who underwent conventional laparoscopic gastrectomy (CLG). In HRLG, suprapancreatic lymph node (LN) dissection was performed in a robotic setting. Clinicopathological characteristics, operative details, and short-term outcomes were analyzed for the patients. Results: The number of LNs retrieved from the suprapancreatic area was significantly greater in the HRLG group (11.27±5.46 vs. 9.17±5.19, P=0.010). C-reactive protein levels were greater in the CLG group on both postoperative day (POD) 1 (5.11±2.64 vs. 4.29±2.38, P=0.030) and POD 5 (9.86±6.51 vs. 7.75±5.17, P=0.019). In addition, the neutrophil-to-lymphocyte ratio was significantly greater in the CLG group on both POD 1 (7.44±4.72 vs. 6.16±2.91, P=0.031) and POD 5 (4.87±3.75 vs. 3.81±1.87, P=0.020). Pulmonary complications occurred only in the CLG group (4/88 [4.5%] vs. 0/88 [0%], P=0.043). Conclusions: HRLG is superior to CLG in terms of suprapancreatic LN dissection and postoperative inflammatory response.

Keywords

Acknowledgement

This research was supported by a grant from the National Research Foundation of Korea (grant No. 2020R1A2C1012007).

References

  1. Mueller JL, Kim DH, Stapleton S, Cauley CE, Chang DC, Park CH, et al. Nature versus nurture: the impact of nativity and site of treatment on survival for gastric cancer. Gastric Cancer 2019;22:446-455. https://doi.org/10.1007/s10120-018-0869-z
  2. Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019;270:983-991. https://doi.org/10.1097/SLA.0000000000003217
  3. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, et al. 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. https://doi.org/10.1097/SLA.0000000000001346
  4. Ploussard G, de la Taille A, Moulin M, Vordos D, Hoznek A, Abbou CC, et al. Comparisons of the perioperative, functional, and oncologic outcomes after robot-assisted versus pure extraperitoneal laparoscopic radical prostatectomy. Eur Urol 2014;65:610-619. https://doi.org/10.1016/j.eururo.2012.11.049
  5. Shah CA, Beck T, Liao JB, Giannakopoulos NV, Veljovich D, Paley P. Surgical and oncologic outcomes after robotic radical hysterectomy as compared to open radical hysterectomy in the treatment of early cervical cancer. J Gynecol Oncol 2017;28:e82. https://doi.org/10.3802/jgo.2017.28.e82
  6. Koh DC, Tsang CB, Kim SH. A new application of the four-arm standard da Vinci® surgical system: totally robotic-assisted left-sided colon or rectal resection. Surg Endosc 2011;25:1945-1952. https://doi.org/10.1007/s00464-010-1492-1
  7. Kim VB, Chapman WH 3rd, Albrecht RJ, Bailey BM, Young JA, Nifong LW, et al. Early experience with telemanipulative robot-assisted laparoscopic cholecystectomy using da Vinci. Surg Laparosc Endosc Percutan Tech 2002;12:33-40. https://doi.org/10.1097/00129689-200202000-00006
  8. Tokunaga M, Sugisawa N, Kondo J, Tanizawa Y, Bando E, Kawamura T, et al. Early phase II study of robot-assisted distal gastrectomy with nodal dissection for clinical stage IA gastric cancer. Gastric Cancer 2014;17:542-547. https://doi.org/10.1007/s10120-013-0293-3
  9. Kim HI, Park MS, Song KJ, Woo Y, Hyung WJ. 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. https://doi.org/10.1016/j.ejso.2013.09.011
  10. Lee HH, Hur H, Jung H, Jeon HM, Park CH, Song KY. Robot-assisted distal gastrectomy for gastric cancer: initial experience. Am J Surg 2011;201:841-845. https://doi.org/10.1016/j.amjsurg.2010.05.013
  11. Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, et al. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg 2016;263:103-109. https://doi.org/10.1097/SLA.0000000000001249
  12. Matsunaga T, Miyauchi W, Kono Y, Shishido Y, Miyatani K, Hanaki T, et al. The advantages of robotic gastrectomy over laparoscopic surgery for gastric cancer. Yonago Acta Med 2020;63:99-106. https://doi.org/10.33160/yam.2020.05.005
  13. Oh SD, Oh SJ. Three-port versus five-port laparoscopic distal gastrectomy for early gastric cancer patients: a propensity score matched case-control study. J Invest Surg 2018;31:455-463. https://doi.org/10.1080/08941939.2017.1355941
  14. Song JH, Son T, Lee S, Choi S, Cho M, Kim YM, et al. D2 lymph node dissections during reduced-port robotic distal subtotal gastrectomy and conventional laparoscopic surgery performed by a single surgeon in a high-volume center: a propensity score-matched analysis. J Gastric Cancer 2020;20:431-441. https://doi.org/10.5230/jgc.2020.20.e36
  15. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer 2019;19:1-48. https://doi.org/10.5230/jgc.2019.19.e8
  16. Son T, Hyung WJ. Laparoscopic gastric cancer surgery: current evidence and future perspectives. World J Gastroenterol 2016;22:727-735. https://doi.org/10.3748/wjg.v22.i2.727
  17. Omil-Lima DO, Gupta K, Calaway AC, Zell MA. Historical considerations and surgical quality improvement in robotic prostatectomy. Urol Clin North Am 2021;48:35-44. https://doi.org/10.1016/j.ucl.2020.09.015
  18. Seo HS, Shim JH, Jeon HM, Park CH, Song KY. Postoperative pancreatic fistula after robot distal gastrectomy. J Surg Res 2015;194:361-366. https://doi.org/10.1016/j.jss.2014.10.022
  19. Liu H, Kinoshita T, Tonouchi A, Kaito A, Tokunaga M. What are the reasons for a longer operation time in robotic gastrectomy than in laparoscopic gastrectomy for stomach cancer? Surg Endosc 2019;33:192-198. https://doi.org/10.1007/s00464-018-6294-x