Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma
Background Robot‐assisted gastrectomy (RAG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopically assisted gastrectomy (LAG) and open gastrectomy (OG) for gastric cancer. The aim of this study was to determine the extent of evide...
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Published in | British journal of surgery Vol. 100; no. 12; pp. 1566 - 1578 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Chichester, UK
John Wiley & Sons, Ltd
01.11.2013
Oxford University Press |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Robot‐assisted gastrectomy (RAG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopically assisted gastrectomy (LAG) and open gastrectomy (OG) for gastric cancer. The aim of this study was to determine the extent of evidence in support of these ideals.
Methods
A systematic review of the three operation types (RAG, LAG and OG) was carried out to evaluate short‐term outcomes including duration of operation, retrieved lymph nodes, estimated blood loss, resection margin status, technical postoperative complications and hospital stay.
Results
Nine non‐randomized observational clinical studies involving 7200 patients satisfied the eligibility criteria. RAG was associated with longer operating times than LAG and OG (weighted mean difference 61·99 and 65·73 min respectively; P ≤ 0·001). The number of retrieved lymph nodes and the resection margin length in RAG were comparable with those of LAG and OG. Estimated blood loss was significantly less in RAG than in OG (P = 0·002), but not LAG. Mean hospital stay for RAG was similar to that for LAG (P = 0·14). In contrast, hospital stay was significantly shorter, by a mean of 2·18 days, for RAG compared with OG (P < 0·001). Postoperative complications were similar for all three operative approaches.
Conclusion
Short‐term oncological outcomes of RAG were comparable with those of the other approaches. LAG was a shorter procedure and less expensive than RAG. Future studies involving RAG should focus on minimizing duration of operation and reducing cost.
Expensive, but no great advantage for robotics |
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Bibliography: | Table S1 Modified Methodological Index for Non-randomized Studies score for quality assessment in the meta-analysis (Word document)Table S2 Subgroup analyses performed using large patient numbers, matched patient factors, matched operation factors and high-quality studies (Word document) ArticleID:BJS9242 ark:/67375/WNG-XCXMK4KV-2 istex:4D6DC58AFD04AE3AB8468CBE6771DC965B0D686B ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3 |
ISSN: | 0007-1323 1365-2168 |
DOI: | 10.1002/bjs.9242 |