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Robotic gastrectomy is more beneficial for advanced than early-stage gastric cancer: a comparison with laparoscopic gastrectomy using propensity score matching

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Abstract

Background

Gastric cancer is the fifth most prevalent malignancy globally and the fourth major contributor to cancer-related mortality. The comparative effectiveness of robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) at different stages of gastric cancer is unclear regarding surgical and survival outcomes. We compared surgical and survival outcomes between RG and LG in early-stage (cStage I) and advanced (cStage II/III) gastric cancers to elucidate the difference in the efficacy of RG across various stages of gastric cancer.

Methods

We identified 299 patients (LG, 170; RG, 129) with cStage II/III disease and 569 (LG, 455; RG, 114) with cStage I disease who underwent either LG or RG. Following propensity score matching for RG and LG, 118 pairs were selected for cStage II/II and 113 pairs for cStage I. Surgical and survival outcomes of LG and RG were separately compared for cStage II/III and cStage I.

Results

In cStage II/III, RG showed significantly fewer intra-abdominal complications of Clavien–Dindo (C.D.) Grade ≥ III in the RG group than in the LG group (LG = 8.5 vs. RG = 1.7%, P = 0.033). Multivariate analysis identified LG as an independent risk factor for intra-abdominal complications of C.D. Grade ≥ III (OR 5.69, 95% CI 1.17–27.70, P = 0.031). However, in cStage I, no difference in surgical outcomes between LG and RG was observed. No differences were observed in survival outcomes between LG and RG in both cStage I or cStage II/III.

Conclusions

The real benefit of RG was demonstrated in surgical outcomes, especially for advanced-stage gastric cancer.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

Funding

No grant support was received for this manuscript.

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Authors and Affiliations

  1. Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-Ku, Niigata City, Niigata Prefecture, 950-1197, Japan

    Shirou Kuwabara, Kazuaki Kobayashi & Natsuru Sudo

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  1. Shirou Kuwabara
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  3. Natsuru Sudo
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Contributions

Study conception and design: Shirou Kuwabara. Acquisition of data: Shirou Kuwabara, Kazuaki Kobayashi, and Natsuru Sudo. Data analysis and interpretation: Shirou Kuwabara, Kazuaki Kobayashi, and Natsuru Sudo. Manuscript drafting: Shirou Kuwabara. Critical revision of the manuscript: Kazuaki Kobayashi and Natsuru Sudo.

Corresponding author

Correspondence to Shirou Kuwabara.

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Disclosures

Shirou Kuwabara, Kazuaki Kobayashi, and Natsuru Sudo have no conflicts of interest or financial ties to disclose..

Ethics approval

All procedures involving human participants performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Niigata City General Hospital (#23-032).

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Kuwabara, S., Kobayashi, K. & Sudo, N. Robotic gastrectomy is more beneficial for advanced than early-stage gastric cancer: a comparison with laparoscopic gastrectomy using propensity score matching. Surg Endosc 38, 3799–3809 (2024). https://doi.org/10.1007/s00464-024-10905-9

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