Open vs robotic gastrectomy with D2 lymphadenectomy: a propensity score-matched analysis on 1469 patients from the IMIGASTRIC prospective database

Langenbecks Arch Surg. 2023 Aug 9;408(1):302. doi: 10.1007/s00423-023-03032-x.

Abstract

Background: Comparative data on D2-robotic gastrectomy (RG) vs D2-open gastrectomy (OG) are lacking in the Literature. Aim of this paper is to compare RG to OG with a focus on D2-lymphadenectomy.

Study design: Data of patients undergoing D2-OG or RG for gastric cancer were retrieved from the international IMIGASTRIC prospective database and compared.

Results: A total of 1469 patients were selected for inclusion in the study. After 1:1 propensity score matching, a total of 580 patients were matched and included in the final analysis, 290 in each group, RG vs OG. RG had longer operation time (210 vs 330 min, p < 0.0001), reduced intraoperative blood loss (155 vs 119.7 ml, p < 0.0001), time to liquid diet (4.4 vs 3 days, p < 0.0001) and to peristalsis (2.4 vs 2 days, p < 0.0001), and length of postoperative stay (11 vs 8 days, p < 0.0001). Morbidity rate was higher in OG (24.1% vs 16.2%, p = 0.017).

Conclusion: RG significantly expedites recovery and reduces the risk of complications compared to OG. However, long-term survival is similar.

Keywords: D2-lymphadenectomy; Gastric cancer; Open gastrectomy; Robotic gastrectomy.

MeSH terms

  • Gastrectomy
  • Humans
  • Laparoscopy*
  • Lymph Node Excision
  • Postoperative Complications / epidemiology
  • Postoperative Complications / surgery
  • Propensity Score
  • Retrospective Studies
  • Robotic Surgical Procedures*
  • Stomach Neoplasms* / surgery
  • Treatment Outcome