Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis. (February 2020)

• Record Type: Journal Article
• Authors: Ryan, Sean; Tameron, Ashley; Murphy, Amy; Hussain, Lala; Dunki-Jacobs, Erik; Lee, David Y.
• Is Part Of: Surgical innovation. Volume 27:Number 1(2020)
• Page Start: 26
• Page End: 31
• Publication Date: 2020-02
• Subjects: gastric cancer -- robotic gastrectomy -- laparoscopic gastrectomy -- robotic versus laparoscopic gastrectomy -- minimally invasive gastrectomy -- National Cancer Database (NCDB); Surgery, Operative -- Periodicals; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgical Procedures, Minimally Invasive -- Periodicals; Diffusion of Innovation -- Periodicals; Chirurgie opératoire -- Périodiques; Chirurgie endoscopique -- Périodiques; Chirurgie laparoscopique -- Périodiques; 617.91
• DOI: 10.1177/1553350619868113
• Languages: English
• ISSNs: 1553-3506

Abstract

Background . We compared the outcomes of laparoscopic-assisted (LA) and robotic-assisted (RA) gastrectomies performed for gastric adenocarcinoma in the National Cancer Database. Methods . The National Cancer Database was queried for patients 18 years old with stages I to III gastric adenocarcinoma who underwent LA or RA gastrectomy. Propensity matching was performed between the 2 groups with regard to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results . A cohort of 1893 (1262 = LA, 631 = RA) patients was identified in a 2:1 propensity matching. The groups were well matched. The rate of negative margin as well as 30- and 90-day mortality were similar between the 2 cohorts. Long-term survival was similar between the 2 groups (median survival 49.2 months in LA vs 56.2 months for RA, P = .405). However, the average number of lymph nodes (LNs) sampled was significantly higher in the RA group compared with the LA group (19.6 vs 17.4, P < .001). Similarly, the percentage of surgeries in which ≥15 LNs were sampled was also greater in the RA group compared with the LA group (63.9% vs 57.6%, P = .010). On multivariable analysis, having 15 LNs or more examined was associated with better survival (hazard ratio = 0.72, 95% confidence interval = 0.60-0.87, P < .001). Advanced age, nodal positivity, and advanced clinical stages were significantly associated with worse survival. Conclusions . RA gastrectomy may allow a greater harvest of LNs, and thus more accurate staging, without increasing short-term adverse outcomes compared with LA gastrectomy. Short-term and long-term outcomes in this well-matched cohort appear comparable for both approaches.