Can Robotic Gastrectomy Surpass Laparoscopic Gastrectomy by Acquiring Long-Term Experience? A Propensity Score Analysis of a 7-Year Experience at a Single Institution

다국어 초록 (Multilingual Abstract)

Purpose: It is hypothesized that robotic gastrectomy may surpass laparoscopic gastrectomy after the operators acquire long-term experience and skills in the manipulation of robotic arms. This study aimed to evaluate the long-term learning curve of robotic distal gastrectomy (RDG) for gastric cancer compared with laparoscopic distal gastrectomy (LDG).
Materials and Methods: From October 2008 to December 2015, patients who underwent LDG (n=809) were matched to patients who underwent RDG (n=232) at a 1:1 ratio, by using a propensity score matching method after stratification for the operative year. The surgical outcomes, such as trends of operative time, blood loss, and complication rate, were compared between the two groups.
Results: The RDG group showed a longer operative time (171.3 minutes vs. 147.6 minutes, P<0.001) but less estimated blood loss (77.6 ml vs. 116.6 ml, P<0.001). The complication rate and postoperative recovery did not differ between the two groups. The RDG group showed a longer operative time and similar estimated blood loss compared with the LDG group after 5 years of experience (operative time: 159.2 minutes vs. 136.0 minutes in 2015, P=0.003; estimated blood loss: 72.9 ml vs. 78.1 ml in 2015, P=0.793).
Conclusions: In terms of short-term surgical outcomes, RDG may not surpass LDG after a long-term experience with the technique.

참고문헌 (Reference)

1 Kim YW, "Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer" 30 : 1547-1552, 2016

2 Son T, "Robotic spleen-preserving total gastrectomy for gastric cancer : comparison with conventional laparoscopic procedure" 28 : 2606-2615, 2014

3 Kim HI, "Rapid and safe learning of robotic gastrectomy for gastric cancer : multidimensional analysis in a comparison with laparoscopic gastrectomy" 40 : 1346-1354, 2014

4 Park SS, "Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons" 26 : 60-67, 2012

5 Suda K, "Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach : a single institutional retrospective comparative cohort study" 29 : 673-685, 2015

6 Kozo Kataoka, "Non-Randomized Confirmatory Trial of Laparoscopy-Assisted Total Gastrectomy and Proximal Gastrectomy with Nodal Dissection for Clinical Stage I Gastric Cancer: Japan Clinical Oncology Group Study JCOG1401" 대한위암학회 16 (16): 93-97, 2016

7 Kim HI, "Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma" 263 : 103-109, 2016

8 Hu Y, "Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer : a randomized controlled trial" 34 : 1350-1357, 2016

9 Kim HH, "Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial)" 251 : 417-420, 2010

10 Kim HH, "Long-term results of laparoscopic gastrectomy for gastric cancer : a large-scale case-control and case-matched Korean multicenter study" 32 : 627-633, 2014

11 Kim YW, "Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer : result of a randomized controlled trial(COACT 0301)" 27 : 4267-4276, 2013

12 Kim W, "Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer : short-term outcomes from a multicenter randomized controlled trial(KLASS-01)" 263 : 28-35, 2016

13 Zhou J, "Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer" 111 : 760-767, 2015

14 Lee JH, "A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer : early results" 19 : 168-173, 2005