J Gastric Cancer.  2013 Sep;13(3):136-148.

Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

• Marano A
• Choi YY
• Hyung WJ
• Kim YM
• Kim J
• Noh SH

Abstract

PURPOSE
To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed.
MATERIALS AND METHODS
A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included.
RESULTS
Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups.
CONCLUSIONS
Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Keyword

Robotics; Laparoscopy; Gastrectomy; Stomach neoplasms

MeSH Terms

Gastrectomy
Humans
Laparoscopy
Length of Stay
Lymph Node Excision
Lymph Nodes
Operative Time
Robotics
Stomach Neoplasms

Figure

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  Fig. 1 Flow diagram for identification of selected articles. Seven cohort studies were finally included in the meta-analysis. RG = robotic gastrectomy; OG = open gastrectomy; LG = laparoscopic gastrectomy.

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  Fig. 2 Forest plots of studies comparing robotic gastrectomy (RG) vs. open gastrectomy (OG) for gastric cancer. (A) Operative time. (B) Blood loss. (C) Number of harvested lymph-nodes. (D) Overall complication rate. (E) Hospital stay. SD = standard deviation; CI = confidence interval; df = degree of freedom.

• 

  Fig. 3 Forest plots of studies comparing robotic gastrectomy (RG) vs. laparoscopic gastrectomy (LG) for gastric cancer. (A) Operative time. (B) Blood loss. (C) Number of harvested lymph nodes. (D) Overall complication rate. (E) Hospital stay. SD = standard deviation; CI = confidence interval; df = degree of freedom.

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  Fig. 4 Begg's funnel plots for identifying publication bias for five perioperative outcomes regarding robotic vs. open and laparoscopic gastrectomy. (A) Operative time. (B) Blood loss. (C) Number of harvested lymph nodes. (D) Overall complication rate. (E) Hospital stay. RG = robotic gastrectomy; OG = open gastrectomy; LG = laparoscopic gastrectomy; SE = standard error; MD = mean difference; OR = odds ratio.

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