Summary of ‘Evaluating the safety of robotic total gastrectomy with D2 lymphadenectomy for gastric cancer against the conventional laparoscopic approach: a systematic review and meta‑analysis’
Evaluating the safety outcomes associated with RTG as compared to LTG for gastric cancer
Gastric cancer remains a significant global health issue, contributing to a substantial percentage of cancer-related deaths worldwide. Despite advances in treatment and surgical techniques, the five-year survival rate for gastric cancer remains low, approximately 20%. The primary surgical intervention for advanced gastric cancer is total gastrectomy with D2 lymphadenectomy, which involves the removal of the entire stomach and specific lymph nodes. However, there is a notable gap in the literature regarding the comparative safety and efficacy of robotic total gastrectomy (RTG) vs.conventional laparoscopic total gastrectomy (LTG), particularly when considering D2 lymphadenectomy. This systematic review and meta-analysis aimed to evaluate the safety outcomes associated with RTG as compared to LTG for gastric cancer.
Methodology
This systematic review adhered to the PRISMA guidelines and registered its methodological approach. A comprehensive literature search was conducted until November 1, 2024, focusing on studies that compared RTG and LTG. The criteria included studies involving adult patients with gastric cancer who required total gastrectomy, with outcomes measured such as anastomotic leakage, Clavien-Dindo Grade ≥ III complications, conversion rates to open surgery, mortality, overall complications, and reoperation rates. The analysis included five studies with a total of 1,131 patients (432 RTG and 700 LTG)
Results
Key Findings
The systematic review revealed no significant differences in safety outcomes between RTG and LTG in the context of total gastrectomy with D2 lymphadenectomy. The findings were as follows:
– Anastomotic Leakage: No significant difference (OR = 0.79, 95% CI: 0.35, 1.78, P = 0.57).
– Clavien-Dindo Grade ≥ III Complications: No significant difference (OR = 0.86, 95% CI: 0.51, 1.45, P = 0.56).
– Conversion to Open Surgery: No significant difference (OR = 0.34, 95% CI: 0.10, 1.18, P = 0.09).
– Mortality: No significant difference (OR = 1.78, 95% CI: 0.23, 13.48, P = 0.58).
– Overall Complications: No significant difference (OR = 0.84, 95% CI: 0.62, 1.14, P = 0.26).
– Reoperation Rates: No significant difference (OR = 0.88, 95% CI: 0.29, 2.67, P = 0.82).
These outcomes indicate that both RTG and LTG are comparable in terms of safety, suggesting that RTG may be considered a viable alternative to LTG, especially in institutions with appropriate robotic capabilities.
Sensitivity Analysis
Sensitivity analyses were performed to confirm the robustness of the findings. The “leave-one-out” technique, which excluded one study at a time, did not yield any significant changes in results. Additionally, using fixed-effects models in the meta-analysis also did not alter the conclusions.
Discussion
The analysis found no significant differences in safety-related outcomes between RTG and LTG for gastric cancer, underscoring the comparative safety of both techniques. Although robotic surgery generally requires longer operative durations and hospital stays, these factors could be attributed to the learning curve associated with robotic techniques.
Despite the findings, the review faced several limitations, including a predominance of retrospective studies, geographic concentration in Asia, and a limited number of studies and patients. Moreover, there was a lack of data on long-term outcomes, which are essential for evaluating the overall effectiveness of robotic surgery.
Conclusion
In conclusion, this systematic review and meta-analysis did not find significant differences in safety outcomes between robotic total gastrectomy and laparoscopic total gastrectomy with D2 lymphadenectomy. With the evidence suggesting comparable safety profiles, RTG may be a suitable alternative in surgical practice, particularly in settings equipped with the necessary technology. Future research should focus on prospective, randomized controlled trials to provide more robust data and evaluate long-term outcomes.
This comprehensive evaluation highlights the importance of further investigating robotic surgery’s role in minimally invasive treatments for gastric cancer, underscoring the need for ongoing research in this evolving field.
READ MORE -> https://link.springer.com/article/10.1007/s11701-025-02219-2
