Open vs robot-assisted laparoscopic gastric resection with D2 lymph node dissection for adenocarcinoma: a case-control study.

BACKGROUND: A population-based case-control study was conducted in order to investigate the advantages of robot-assisted gastric resection (RGR) for gastric cancer as opposed to traditional open gastrectomy (OG).
METHODS: Data were collected in two prospectively maintained databases on patients who underwent a D2 gastrectomy with curative intent for primary gastric adenocarcinoma. All (n = 29) the first consecutive gastric cancer patients submitted to RGR from a referral centre for minimally invasive surgery were matched to control cancers (n = 120) extrapolated from a high volume centre database including patients submitted to OG.
RESULTS: Robot-assisted laparoscopic procedures implied increased operative time (290 vs 222 min, p = 0.004), decreased blood loss (197.6 vs 386.1 mL, p = 0.0001) and shorter hospital stay (9.6 vs 13.4 days, p < 0.0009). There was no difference in the mean number of harvested lymph nodes between the two groups (28.0 vs 31.7, p = 0.023). The total morbidity rate, including major complications such as anastomotic and duodenal suture failure, was comparable between groups (41.4% vs 42.5%; in the RGR and OG, respectively, p = 0.764). Preliminary data on overall survival did not show prognostic differences between the two groups (p = 0.615).
CONCLUSIONS: Robot-assisted surgery fulfils oncologic criteria for D2 dissection and has an oncologic outcome comparable with that of OG. RGR resulted in shorter hospital stays, the loss of less blood and morbidity comparable with that of OG. Randomized clinical trials and longer follow-up are needed to evaluate whether RGR achieves long-term survival rates equivalent to that of open and laparoscopic surgery.