Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6659
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
Minimally invasive surgery (MIS) including laparoscopic and robotic approaches for gastric cancer has been increasingly used because of its beneficial short-term effects over the open approach. However, oncological outcomes are not established.
There have been few reports on the oncological outcomes of MIS for gastric cancer patients, especially for the robotic approach, because a surgical robot remains a relatively new technology. Therefore, this study aimed to determine the prognostic factors of minimally invasive gastrectomy, including laparoscopic and robotic approaches.
This study aimed to determine the prognostic factors of minimally invasive gastrectomy, including laparoscopic and robotic approaches.
This single-institutional retrospective cohort study included 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy between 2009 and 2014. We retrospectively examined 5-year overall survival and recurrence-free survival and investigated factors related to survival.
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 overall survival and recurrence-free survival. The five-year overall survival and recurrence-free survival were 80.3% and 78.2%, respectively. Of all 814 patients, 157 patients (19.3%) underwent robotic gastrectomy and 308 (37.2%) were diagnosed with pathological stage II or III disease. Robotic gastrectomy was an independent positive predictor for recurrence-free survival in pathological stage II/III patients (hazard ratio: 0.56 [0.33-0.96], P = 0.035). Comparison of recurrence-free survival between robotic and laparoscopic approach using propensity score matching analysis verified that with less morbidity in the robotic group (P = 0.005).
Age, ASA status, type of gastrectomy, and pathological T and N status were prognostic factors of minimally invasive gastrectomy for gastric cancer, and the use of a surgical robot may improve its long-term outcomes for advanced gastric cancer.
Future studies to better prove the efficacy of robotic gastrectomy for advanced gastric cancer patients are warranted.