Major early complications following open, laparoscopic and robotic gastrectomy
Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea. British Journal of Surgery
(Impact Factor: 5.54).
12/2012; 99(12). DOI: 10.1002/bjs.8924
Laparoscopic and robotic gastrectomy have been adopted rapidly despite lack of evidence concerning technical safety and controversy regarding additional benefits. This study aimed to compare clinically relevant complications after open, laparoscopic and robotic gastrectomy.
This was a retrospective analysis of prospectively collected data on surgical complications in patients undergoing gastrectomy with curative intent for histologically proven adenocarcinoma between 2005 and 2010 at the Department of Surgery, Yonsei University College of Medicine in Seoul, Korea. Complications were categorized into wound infection, bleeding, anastomotic leak, obstruction, fluid collection and other.
In a total of 5839 patients (4542 open, 861 laparoscopic and 436 robotic gastrectomies), overall complication, reoperation and mortality rates were 10·5, 1·0 and 0·4 per cent respectively. There were no significant differences between the three groups. Ileus (P = 0·001) and intra-abdominal fluid collections (P = 0·013) were commoner after conventional open surgery. However, tumour stage was higher and more complex resections were performed in the open group. Anastomotic leak, the leading cause of death, occurred more often after a minimally invasive approach (P = 0·017).
Laparoscopic and robotic gastrectomy had overall complication and mortality rates similar to those of open surgery, but anastomotic leaks were more common with the minimally invasive techniques. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Available from: Liang Zong
- "Some studies have demonstrated that robotic total and subtotal gastrectomies with D2-lymphade- nectomy are technically feasible and safe, with acceptable surgical and oncological short-term results[15,303132. It is particularly notable that only a few reports have examined the technical feasibility of robotic surgery for gastric cancer till 2011[9,14,17– 19], and the number of patients included in these studies was tooRecently some large sized studies have been conducted to evaluate the efficacy and safety of robotic gastrectomy for gastric cancer[11,13,15,19]. But single comparison and conflict results limited them to conclude persuasible conclusions. "
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Robotic gastrectomy (RG), as an innovation of minimally invasive surgical method, is developing rapidly for gastric cancer. But there is still no consensus on its comparative merit in either subtotal or total gastrectomy compared with laparoscopic and open resections.
Literature searches of PubMed, Embase and Cochrane Library were performed. We combined the data of four studies for RG versus open gastrectomy (OG), and 11 studies for robotic RG versus laparoscopic gastrectomy (LG). Moreover, subgroup analyses of subtotal and total gastrectomies were performed in both RG vs. OG and RG vs. LG.
Totally 12 studies involving 8493 patients met the criteria. RG, similar with LG, significantly reduced the intraoperative blood loss than OG. But the duration of surgery is longer in RG than in both OG and LG. The number of lymph nodes retrieved in RG was close to that in OG and LG (WMD = −0.78 and 95% CI, −2.15−0.59; WMD = 0.63 and 95% CI, −2.24−3.51). And RG did not increase morbidity and mortality in comparison with OG and LG (OR = 0.92 and 95% CI, 0.69−1.23; OR = 0.72 and 95% CI, 0.25−2.06) and (OR = 1.06 and 95% CI, 0.84−1.34; OR = 1.55 and 95% CI, 0.49−4.94). Moreover, subgroup analysis of subtotal and total gastrectomies in both RG vs. OG and RG vs. LG revealed that the scope of surgical dissection was not a positive factor to influence the comparative results of RG vs. OG or LG in surgery time, blood loss, hospital stay, lymph node harvest, morbidity, and mortality.
This meta-analysis highlights that robotic gastrectomy may be a technically feasible alternative for gastric cancer because of its affirmative role in both subtotal and total gastrectomies compared with laparoscopic and open resections.
Available from: wjgnet.com
- "2.1.2 Anastomosis leakage Woo 4 236 9 591 15.8 1.11 [0.34, 3.66] 2011 Zhang 2 97 1 70 3.5 1.45 [0.13, 16.34] 2012 Kim 10 436 18 861 36.9 1.10 [0.50, 2.40] 2012 Yoon 0 36 3 65 7.7 0.24 [0.01, 4.87] "
Available from: Guixiang Liao
- "The rate of anastomotic leakage was described in three studies [4,8,9]. No difference was observed in pooled analysis between 2.78% (14/504) for RG and 1.62% (85/5248) for OG (OR:1.72, "
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ABSTRACT: To evaluate the safety and efficacy of robotic gastrectomy versus open gastrectomy for gastric cancer.
A comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Knowledge was performed. Systematic review was carried out to identify studies comparing robotic gastrectomy and open gastrectomy in gastric cancer. Intraoperative and postoperative outcomes were also analyzed to evaluate the safety and efficacy of the surgery. A fixed effects model or a random effects model was utilized according to the heterogeneity.
Four studies involving 5780 patients with 520 (9.00%) cases of robotic gastrectomy and 5260 (91.00%) cases of open gastrectomy were included in this meta-analysis. Compared to open gastrectomy, robotic gastrectomy has a significantly longer operation time (weighted mean differences (WMD) =92.37, 95% confidence interval (CI): 55.63 to 129.12, P<0.00001), lower blood loss (WMD: -126.08, 95% CI: -189.02 to -63.13, P<0.0001), and shorter hospital stay (WMD = -2.87; 95% CI: -4.17 to -1.56; P<0.0001). No statistical difference was noted based on the rate of overall postoperative complication, wound infection, bleeding, number of harvested lymph nodes, anastomotic leakage and postoperative mortality rate.
The results of this meta-analysis suggest that robotic gastrectomy is a better alternative technique to open gastrectomy for gastric cancer. However, more prospective, well-designed, multicenter, randomized controlled trials are necessary to further evaluate the safety and efficacy as well as the long-term outcome.
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