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Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In p...

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Autores principales: Zizzo, Maurizio, Zanelli, Magda, Sanguedolce, Francesca, Torricelli, Federica, Morini, Andrea, Tumiati, David, Mereu, Federica, Zuliani, Antonia Lavinia, Palicelli, Andrea, Ascani, Stefano, Giunta, Alessandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231199/
https://www.ncbi.nlm.nih.gov/pubmed/35744096
http://dx.doi.org/10.3390/medicina58060834
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author Zizzo, Maurizio
Zanelli, Magda
Sanguedolce, Francesca
Torricelli, Federica
Morini, Andrea
Tumiati, David
Mereu, Federica
Zuliani, Antonia Lavinia
Palicelli, Andrea
Ascani, Stefano
Giunta, Alessandro
author_facet Zizzo, Maurizio
Zanelli, Magda
Sanguedolce, Francesca
Torricelli, Federica
Morini, Andrea
Tumiati, David
Mereu, Federica
Zuliani, Antonia Lavinia
Palicelli, Andrea
Ascani, Stefano
Giunta, Alessandro
author_sort Zizzo, Maurizio
collection PubMed
description Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment. However, LG suffers from technical limitations and drawbacks, such as a two-dimensional surgical field of view, limited movement of laparoscopic tools, unavoidable physiological tremors and discomfort for operating surgeon. Therefore, robotic surgery has been developed to address such limitations. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines in order to investigate the benefits and harms of robotic gastrectomy (RG) compared to the LG. PubMed/MEDLINE, Scopus, Cochrane Library (Cochrane Database of Systematic Re-views, Cochrane Central Register of Controlled Trials-CENTRAL) and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature. Results: The 7 included meta-analyses covered an approximately 20 years-study period (2000–2020). Almost all studies included in the meta-analyses were retrospective ones and originated from Asian countries (China and Korea, in particular). Examined overall population ranged from 3176 to 17,712 patients. If compared to LG, RG showed both operative advantages (operative time, estimated blood loss, number of retrieved lymph nodes) and perioperative ones (time to first flatus, time to restart oral intake, length of hospitalization, overall complications, Clavien-Dindo (CD) ≥ III complications, pancreatic complications), in the absence of clear differences of oncological outcomes. However, costs of robotic approach appear significant. Conclusions: It is impossible to make strong recommendations, due to the statistical weakness of the included studies. Further randomized, possibly multicenter trials are strongly recommended, if we want to have our results confirmed.
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spelling pubmed-92311992022-06-25 Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review Zizzo, Maurizio Zanelli, Magda Sanguedolce, Francesca Torricelli, Federica Morini, Andrea Tumiati, David Mereu, Federica Zuliani, Antonia Lavinia Palicelli, Andrea Ascani, Stefano Giunta, Alessandro Medicina (Kaunas) Systematic Review Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment. However, LG suffers from technical limitations and drawbacks, such as a two-dimensional surgical field of view, limited movement of laparoscopic tools, unavoidable physiological tremors and discomfort for operating surgeon. Therefore, robotic surgery has been developed to address such limitations. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines in order to investigate the benefits and harms of robotic gastrectomy (RG) compared to the LG. PubMed/MEDLINE, Scopus, Cochrane Library (Cochrane Database of Systematic Re-views, Cochrane Central Register of Controlled Trials-CENTRAL) and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature. Results: The 7 included meta-analyses covered an approximately 20 years-study period (2000–2020). Almost all studies included in the meta-analyses were retrospective ones and originated from Asian countries (China and Korea, in particular). Examined overall population ranged from 3176 to 17,712 patients. If compared to LG, RG showed both operative advantages (operative time, estimated blood loss, number of retrieved lymph nodes) and perioperative ones (time to first flatus, time to restart oral intake, length of hospitalization, overall complications, Clavien-Dindo (CD) ≥ III complications, pancreatic complications), in the absence of clear differences of oncological outcomes. However, costs of robotic approach appear significant. Conclusions: It is impossible to make strong recommendations, due to the statistical weakness of the included studies. Further randomized, possibly multicenter trials are strongly recommended, if we want to have our results confirmed. MDPI 2022-06-20 /pmc/articles/PMC9231199/ /pubmed/35744096 http://dx.doi.org/10.3390/medicina58060834 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Zizzo, Maurizio
Zanelli, Magda
Sanguedolce, Francesca
Torricelli, Federica
Morini, Andrea
Tumiati, David
Mereu, Federica
Zuliani, Antonia Lavinia
Palicelli, Andrea
Ascani, Stefano
Giunta, Alessandro
Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review
title Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review
title_full Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review
title_fullStr Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review
title_full_unstemmed Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review
title_short Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review
title_sort robotic versus laparoscopic gastrectomy for gastric cancer: an updated systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231199/
https://www.ncbi.nlm.nih.gov/pubmed/35744096
http://dx.doi.org/10.3390/medicina58060834
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