Work

Robotic versus laparoscopic gastrectomy for localized gastric cancer: Meta-analysis of propensity score-matched studies with the implementation of a novel morbidity index

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Localised gastric cancer is potentially curable via minimally invasive radical gastrectomy. Our systematic review assessed the safety and efficacy of robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) for localised gastric cancer based on propensity-score matching studies. PubMed, Cochrane, Medline, Embase, Web of science and Scopus were systematically searched for publications before April 2023. We used mean difference for continuous data and risk-ratios for dichotomous data. Random and fixed-effect models were utilized depending on degree of clinical heterogeneity. Additionally, we introduced a novel index as an additional parameter of morbidity to improve the sensitivity and accuracy of intervention effect. 15 PSM studies involving 10,389 patients were included in the final analysis. RG demonstrated significantly lower morbidity in terms of overall complications [RR 0.75 (95 %CI 0.62, 0.91) p = 0.0004], Clavien-Dindo ≥ IIIa morbidity rate [RR 0.71, (95 %CI 0.58, 0.86) p = 0.0007] and intra-abdominal complication (IAC) [RR 0.73 (95 %CI 0.57, 0.94), p = 0.02)]. These findings were further supported by the novel morbidity index. There is no significant difference in mortality rate. RG had longer operation time [MD 36.62, (95 %CI 26.74, 46.51) p < 0.0001], lesser blood loss [MD -16.90 (95 %CI -25.38, −8.42), p < 0.0001)] and higher lymph node yield [MD 1.53 (95 %CI 0.51, 2.55), p = 0.003]. Cost was significantly higher in RG [MD +3295.78 USD (95 %CI 2813.13, 3778.42) p < 0.00001]. Parameters of recovery (i.e. hospital stay) demonstrated no clinical significance. Long-term oncological outcomes were largely comparable. Despite longer operation time and cost, RG is safe and feasible with potential improvements in morbidity and short-term outcomes.

Source: Asian Journal of Surgery

DOI: 10.1016/j.asjsur.2025.04.120

Authors: Seng Pei Khaw, Martin TW. Kueh, Fahd Adeeb, Bikramjit Pal, Kartik Saxena, Bijendra Patel

Institutions: RCSI & UCD Malaysia Campus, Queen Mary University of London, Barts Cancer Institute, University College Dublin

Language: English

Topic: Gastric Cancer Management and Outcomes

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,200