Robot-assisted versus totally laparoscopic distal gastrectomy for gastric cancer: a retrospective propensity score-matched analysis

Abstract

Background: Robot-assisted gastrectomy is increasingly performed, but rarely reported for delta-shaped anastomosis. This study compared surgical outcomes of robot-assisted laparoscopic distal gastrectomy with delta-shaped anastomosis (RALG-d) with totally laparoscopic distal gastrectomy with the same anastomosis (LAG-d) by a propensity score matching (PSM). Methods: From March 2012 to April 2019, 31 patients underwent RALG-d, and 468 patients underwent LAG-d for gastric cancer by a single surgeon. Surgical outcomes were compared by PSM. Results: After PSM, 30 patients were included into the RALG-d group, and 118 patients into the LAG-d group. All of the covariates were balanced, except TNM stage. Mean operation times were longer in the RALG-d group than the LAG-d group (P <0.001). The number of retrieved lymph nodes and length of hospital stay were not significantly different (P = 0.110 and P = 0.939, respectively). The flatus passage was faster in the RALG-d group (P = 0.002). The numeric rating scale for pain (NRS) on postoperative day 3 in the RALG-d group was higher than that of the LAG-d group (P = 0.051), while those on postoperative days 1 and 5 were similar between the two groups. Overall, postoperative complications were experienced by 1 patient (3.2%) in the RALG-d group and 28 (6.0%) in the LAG-d group (P = 0.811). There was no operation-related mortality and no open conversion in both groups. Conclusions: Our study shows comparable surgical outcomes of RALG-d, especially rapid recovery of intestinal function. RALG-d can be a safe and feasible treatment option for gastric cancer.