Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2021; 27(39): 6659-6672
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6659
Prognostic factors of minimally invasive surgery for gastric cancer: Does robotic gastrectomy bring oncological benefit?
Masaya Nakauchi, Koichi Suda, Susumu Shibasaki, Kenichi Nakamura, Shinichi Kadoya, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama
Masaya Nakauchi, Koichi Suda, Susumu Shibasaki, Kenichi Nakamura, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama, Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
Shinichi Kadoya, Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8535, Ishikawa, Japan
Author contributions: Nakauchi M, Suda K, Shibasaki S, and Uyama I provided substantial contributions to the conception and design of the study; Nakauchi M, Shibasaki S, Nakamura K, Kikuchi K, Kadoya S, and Inaba K contributed to the acquisition, analysis, and interpretation of the data; Nakauchi M performed the statistical analysis; Nakauchi M, Suda K, and Uyama I drafted the article and made critical revisions related to important intellectual content of the manuscript; all the authors have read and approved the final version to be published.
Institutional review board statement: This study was approved by the institutional review board of Fujita Health University.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: All authors have no commercial association or financial involvement that might pose a conflict of interest in connection with the submitted article. I. U. received lecture fees from Intuitive Surgical, Inc. K. S. and K. K. received funding from Medicaroid, Inc. in relation to Collaborative Laboratory for Research and Development in Advanced Surgical Technology. K.S. also received advisory fees from Medicaroid, Inc. outside of the submitted work.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Koichi Suda, FACS, MD, PhD, Professor, Department of Gastroenterological Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Aichi, Japan. ko-suda@nifty.com
Received: April 26, 2021
Peer-review started: April 26, 2021
First decision: June 13, 2021
Revised: June 18, 2021
Accepted: September 23, 2021
Article in press: September 23, 2021
Published online: October 21, 2021
Processing time: 176 Days and 19.6 Hours
Abstract
BACKGROUND

Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer. Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades. Thus far, only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.

AIM

To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.

METHODS

This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period. After excluding 125 patients with non-curative surgery (n = 77), other synchronous cancer (n = 2), remnant gastric cancer (n = 25), insufficient physical function (n = 13), and open gastrectomy (n = 8), a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined. Accordingly, 5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses, while factors associated with survival were determined using multivariate analysis.

RESULTS

Our analysis showed that age > 65 years, American Society of Anesthesiologists (ASA) physical status 3, total or proximal gastrectomy, and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrence-free survival. Accordingly, the included patients had a 5-year overall and recurrence-free survival of 80.3% and 78.2%, respectively. Among the 814 patients, 157 (19.3%) underwent robotic gastrectomy, while 308 (37.2%) were diagnosed with pathological stage II or III disease. Notably, our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III [hazard ratio: 0.56 (0.33-0.96), P = 0.035]. Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity (P = 0.005).

CONCLUSION

Age, ASA status, gastrectomy type, and pathological T and N status were prognostic factors of minimally invasive gastrectomy, with the robot approach possibly improving long-term outcomes of advanced gastric cancer.

Keywords: Laparoscopy; Gastric cancer; Minimally invasive surgery; Prognostic factor; Stomach neoplasms

Core Tip: This retrospective cohort study on 814 patients undergoing minimally invasive surgery for primary gastric cancer revealed a 5-year overall and recurrence-free survival of 80.3% and 78.2%, respectively. Moreover, our analysis identified age, American Society of Anesthesiologists status, type of gastrectomy, and pathological T and N status as prognostic predictors for overall and recurrence-free survival. The robotic approach was also identified as an independent positive predictor for recurrence-free survival in patients with pathological stage II/III disease, confirmed by the lesser morbidity in the robotic group following propensity score analysis.