International journal of surgery (London, England) · 2025
Assessment of robotic versus laparoscopic gastrectomy for gastric cancer patients with intraoperative technical complexity: a multicenter retrospective study.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Zheng Hua-Long, Wei Ling-Hua, Li Tai-Yuan, Zhang Li, She Jun-Jun, Jia Bao-Qing, Qin Xin-Gan, Ren Shuang-Yi, Yao Hong-Liang, Liu Dong-Ning, Liang Han, Shi Fei-Yu, Li Peng, Li Bo-Pei, Zhang Xin-Sheng, Liu Kui-Jie, Zheng Chao-Hui, Huang Chang-Ming, Li Ping, Chinese Multi-center Research Group of Robotic Gastric Surgery
Аннотация
BACKGROUND: While robotic gastrectomy (RG) is increasingly used in gastric cancer surgery, its potential advantages over laparoscopic gastrectomy (LG) in intraoperative technical complexity (ITC) cases remain debated.
METHODS: This retrospective cohort study included 3534 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals. ITC was defined by any of the following criteria: operative time exceeding the third quartile, intraoperative estimated blood loss ≥400 mL, or conversion to open surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were conducted to compare short- and long-term outcomes.
RESULTS: Patients with ITC comprised 25.9% (916/3534) of the cohort (RG: 260, LG: 656). After baseline adjustment, RG and LG groups were comparable in both PSM and IPTW cohorts. RG showed lower overall postoperative complications (11.5% vs. 20.1%, P = 0.003), particularly pneumonia (2.3% vs. 11.0%, P < 0.001) and shorter postoperative hospital stay (9.33 ± 4.41 vs. 10.77 ± 5.91 days, P < 0.001) compared to LG. These differences remained significant after PSM and IPTW analysis. The 3-year overall survival (83% vs. 78.8%, P = 0.15), disease-free survival (81.9% vs. 76.2%, P = 0.073), and cumulative recurrence risk (16.9% vs. 20%, P = 0.26) were comparable between RG and LG groups, consistent after PSM and IPTW. Multivariate analysis indicated that the surgical approach was not an independent factor influencing technical complexity.
CONCLUSIONS: For patients with ITC, RG demonstrated superior short-term and comparable long-term outcomes than LG.
METHODS: This retrospective cohort study included 3534 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals. ITC was defined by any of the following criteria: operative time exceeding the third quartile, intraoperative estimated blood loss ≥400 mL, or conversion to open surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were conducted to compare short- and long-term outcomes.
RESULTS: Patients with ITC comprised 25.9% (916/3534) of the cohort (RG: 260, LG: 656). After baseline adjustment, RG and LG groups were comparable in both PSM and IPTW cohorts. RG showed lower overall postoperative complications (11.5% vs. 20.1%, P = 0.003), particularly pneumonia (2.3% vs. 11.0%, P < 0.001) and shorter postoperative hospital stay (9.33 ± 4.41 vs. 10.77 ± 5.91 days, P < 0.001) compared to LG. These differences remained significant after PSM and IPTW analysis. The 3-year overall survival (83% vs. 78.8%, P = 0.15), disease-free survival (81.9% vs. 76.2%, P = 0.073), and cumulative recurrence risk (16.9% vs. 20%, P = 0.26) were comparable between RG and LG groups, consistent after PSM and IPTW. Multivariate analysis indicated that the surgical approach was not an independent factor influencing technical complexity.
CONCLUSIONS: For patients with ITC, RG demonstrated superior short-term and comparable long-term outcomes than LG.