Kazutaka Obama1,2, Yoo-Min Kim3,4, Dae Ryong Kang5, Taeil Son1,6,7, Hyoung-Il Kim1,6,7, Sung Hoon Noh1,3,6,7, Woo Jin Hyung8,9,10,11. 1. Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea. 2. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea. 4. Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea. 5. Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea. 6. Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea. 7. Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea. 8. Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea. wjhyung@yuhs.ac. 9. Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea. wjhyung@yuhs.ac. 10. Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea. wjhyung@yuhs.ac. 11. Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea. wjhyung@yuhs.ac.
Abstract
BACKGROUND: Initial experiences with robotic gastrectomy (RG) for gastric cancer have demonstrated favorable short-term outcomes, suggesting that RG is an effective alternative to laparoscopic gastrectomy (LG). However, data on long-term survival and recurrence after RG for gastric cancer have yet to be reported. The objective of this study was to assess long-term outcomes after RG compared with LG. METHODS: We retrospectively evaluated 313 and 524 patients who underwent RG or LG, respectively, for gastric cancer between July 2005 and December 2009. We compared long-term outcomes using the entire and a propensity-score matched cohort. RESULTS: The entire cohort analysis revealed no statistically significant differences in 5-year overall survival(OS) or relapse-free survival(RFS) (p = 0.4112 and p = 0.8733, respectively): 93.3% [95% confidence interval (CI) 89.9-95.6] and 90.7% (95% CI, 86.9-93.5) after RG and 91.6% (95% CI 88.9-93.7) and 90.5% (95% CI 87.6-92.7) after LG, respectively; hazard ratios for death and recurrence in the robotic group were 0.828 (95% CI, 0.528-1.299; p = 0.4119) and 0.968 (95% CI, 0.649-1.445; p = 0.8741), respectively. The propensity-matched cohort analysis demonstrated no statistically significant differences for 5-year OS or RFS (p = 0.5207 and p = 0.2293, respectively): 93.2% and 90.7% after RG and 94.2% and 92.6% after LG, respectively; hazard ratios for death and recurrence in the robotic group were 1.194 (95% CI, 0.695-2.062; p = 0.5214) and 1.343 (95% CI, 0.830-2.192; p = 0.2321), respectively. CONCLUSION: The potential technical superiority of robotic system over laparoscopy did not improve oncological outcomes after gastrectomy. Long-term oncological outcomes were not different between RG and LG. Nevertheless, robotic applications in minimally invasive gastric cancer surgery may be an oncologically safe alternative.
BACKGROUND: Initial experiences with robotic gastrectomy (RG) for gastric cancer have demonstrated favorable short-term outcomes, suggesting that RG is an effective alternative to laparoscopic gastrectomy (LG). However, data on long-term survival and recurrence after RG for gastric cancer have yet to be reported. The objective of this study was to assess long-term outcomes after RG compared with LG. METHODS: We retrospectively evaluated 313 and 524 patients who underwent RG or LG, respectively, for gastric cancer between July 2005 and December 2009. We compared long-term outcomes using the entire and a propensity-score matched cohort. RESULTS: The entire cohort analysis revealed no statistically significant differences in 5-year overall survival(OS) or relapse-free survival(RFS) (p = 0.4112 and p = 0.8733, respectively): 93.3% [95% confidence interval (CI) 89.9-95.6] and 90.7% (95% CI, 86.9-93.5) after RG and 91.6% (95% CI 88.9-93.7) and 90.5% (95% CI 87.6-92.7) after LG, respectively; hazard ratios for death and recurrence in the robotic group were 0.828 (95% CI, 0.528-1.299; p = 0.4119) and 0.968 (95% CI, 0.649-1.445; p = 0.8741), respectively. The propensity-matched cohort analysis demonstrated no statistically significant differences for 5-year OS or RFS (p = 0.5207 and p = 0.2293, respectively): 93.2% and 90.7% after RG and 94.2% and 92.6% after LG, respectively; hazard ratios for death and recurrence in the robotic group were 1.194 (95% CI, 0.695-2.062; p = 0.5214) and 1.343 (95% CI, 0.830-2.192; p = 0.2321), respectively. CONCLUSION: The potential technical superiority of robotic system over laparoscopy did not improve oncological outcomes after gastrectomy. Long-term oncological outcomes were not different between RG and LG. Nevertheless, robotic applications in minimally invasive gastric cancer surgery may be an oncologically safe alternative.
Authors: Hyung-Ho Kim; Sang-Uk Han; Min-Chan Kim; Woo Jin Hyung; Wook Kim; Hyuk-Joon Lee; Seung Wan Ryu; Gyu Seok Cho; Chan Young Kim; Han-Kwang Yang; Do Joong Park; Kyo Young Song; Sang Il Lee; Seong Yeob Ryu; Joo Ho Lee Journal: J Korean Surg Soc Date: 2013-01-29