Robotic versus laparoscopic versus open gastrectomy for gastric adenocarcinoma: 2015 Canadian Surgery Forum

Robotic surgery has gained acceptance in oncological surgery. Its relevance in gastric cancer surgery is being examined. The study presents preliminary comparison of operative and postoperative outcome between robotic, laparoscopic and open gastrectomies for gastric adenocarcinoma. We included a retrospective cohort of 85 consecutive patients who underwent total or partial gastrectomy for gastric adenocarcinoma at Rambam Hospital during 2012–2015. For each patient data were collected on basic demographic characteristics, BMI, operating room time (ORT), number of dissected lymph nodes (LN), length of hospitalization (LOH), intra- and postoperative complications. Nonparametric statistical tests were the Mann–Whitney and Kruskal–Wallis tests, used for group comparisons. Study population included 55 patients after total gastrectomies, 10 of them robotic, and 30 partial gastrectomies, 12 of them robotic. Age, sex and BMI were similar between patients who underwent robotic, laparoscopic and open procedures. Median length of hospitalization (LOH) for robotic total gastrectomy was 4.5 days and it was significantly shorter than both laparoscopic total gastrectomy (LTG) 7.0 days (p = 0.003) and open total gastrectomy (OTG) 9.0 days (p < 0.001). Similar significant differences in LOH among the 3 groups were observed among patients who underwent partial gastrectomy, but the comparison between robotic and laparoscopic procedures was limited due to small numbers of LPG. Median ORT was significantly longer among robotic gastrectomies compared with open, the difference was 64 minute in total gastrectomy group and 145 minute in partial gastrectomy group (p < 0.001 for both differences), but the difference in ORT between laparoscopic and robotic procedures were smaller and nonsignificant. The number of dissected LNs was similar among the 3 procedures in total gasrectomies. In partial gastrectomies, the number of dissected LNs was even higher among both laparoscopic and robotic gastrectomies than open (p < 0.001). Robotic total and partial gastrectomies for gastric adenocarcinoma are associated with oncologically adequate lymphadenectomy and faster patient recovery, but longer operating time.