Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer

Abstract

Aims

The authors aimed to compare the surgical performance and the short-term clinical outcomes of robotic assisted laparoscopic distal gastrectomy (RADG) with laparoscopy-assisted distal gastrectomy (LADG) in distal gastric cancer patients.

Method

From April 2009 to August 2010, 62 patients underwent LADG and 30 patients underwent RADG for preoperative stage I distal gastric cancer by one surgeon at the National Cancer Center, Korea. Surgical performance was measured using lymph node (LN) dissection time and number of retrieved LNs, which were viewed as surrogates of technical ease and oncologic quality.

Results

In clinicopathologic characteristics, mean age, depth of invasion and stage were significantly different between the LADG and RADG group. Mean dissection time at each LN station was greater in the RADG group, but no significant intergroup difference was found for numbers of retrieved LNs. Furthermore, proximal resection margins were smaller, and hospital costs were higher in the RADG group. In terms of the RADG learning curve, mean LN dissection time was smaller in the late RADG group (n = 15) than in the early RADG group (n = 15) for 4sb/4d, 5, 7-12a stations, but numbers of retrieved LNs per station were similar.

Conclusion

With the exception of operating time and cost, the numbers of retrieved LNs and the short-term clinical outcomes of RADG were found to be comparable to those of LADG, despite the surgeon’s familiarity with LADG and lack of RADG experience. Further studies are needed to evaluate objectively ergonomic comfort and to quantify the patient benefits conferred by robotic surgery.

Introduction

The use of laparoscopy-assisted gastrectomy (LAG) in early gastric cancer (EGC) has now gained worldwide acceptance.1, 2 Previous studies have demonstrated the safety and feasibility of LAG and its several advantages, which include; reduced invasiveness, less pain, earlier recovery of bowel movements, and shorter hospital stays, over open gastrectomy.2, 3 However, LAG also has the disadvantages of 2-D (two-dimensional) imaging, hand tremor amplification, restricted ranges of instrument movement, and the uncomfortable position forced upon surgeons, and thus, robotic surgery was developed to address these limitations of laparoscopic surgery.4, 5

Robotic systems have 3-D imaging, a tremor filter, and an articulated EndoWrist (Intuitive Surgical Inc., Sunnyvale, CA) that mimics the movements and dexterity of the human wrist and hand. These features facilitate precise control during technically challenging tasks, such as, fine suturing, and enable surgeons to perform operations easily in comfort. Interestingly, robotic surgery has been recently adopted for the treatment of prostate cancer and has been applied to cardiac and gynecologic surgery.6, 7, 8

In the gastric surgery field, these benefits of robotic surgery allow surgeons to dissect lymph nodes (LNs) precisely with an internally articulated EndoWrist. Song et al.⁹ have reported that LN dissection of more than D1 + β was possible in all case and the number of LNs dissected is no less than that of conventional open surgery. However, no study has yet objectively evaluated the ergonomic benefits of robotic assisted laparoscopic distal gastrectomy in distal gastric cancer patients. Furthermore, few studies have demonstrated the safety and feasibility of robotic assisted laparoscopic gastrectomy based on analyses of clinical outcomes.9, 10

Therefore, in this study, we undertook to compare the surgical performance and the short-term clinical outcomes of robotic assisted laparoscopic distal gastrectomy (RADG) and laparoscopy-assisted distal gastrectomy (LADG) in distal gastric cancer patients.