No difference between short-term surgical outcomes of Robotic vs. Laparoscopic Gastrectomy: Study

Robotic gastrectomy (RG) for gastric cancer may be associated with decreased incidence of intra-abdominal infectious complications, including pancreatic fistula, leakage, and abscess. Prospective randomized clinical trials comparing laparoscopic gastrectomy (LG) and RG are thus required.

A team of researchers conducted a study to compare the short-term surgical outcomes of RG with those of LG for patients with gastric cancer.

In this phase 3, prospective superiority randomized clinical trial of RG vs LG regarding the reduction of complications, 241 patients with resectable gastric cancer (clinical stages I-III) was enrolled between April 1, 2018, and October 31, 2020.

The primary endpoint was the incidence of postoperative intra-abdominal infectious complications. Secondary endpoints were the incidence of any complications, surgical results, postoperative courses, and oncologic outcomes. The modified intention-to-treat population excluded patients who had been randomized and met the post-randomization exclusion criteria. There was also a per-protocol population for analysis of postoperative complications.

The results of the study are as follows:

• This study enrolled 241 patients, with 236 patients in the modified intention-to-treat population.
• There was no significant difference in the incidence of intra-abdominal infectious complications.
• Of 241 patients, 122 were randomly assigned to the LG group, and 119 patients were randomly assigned to the RG group.
• Two of the 122 patients (1.6%) in the LG group converted from LG to open surgery, and 4 of 119 patients (3.4%) in the RG group converted from RG to open or laparoscopic surgery, with no significant difference.
• Finally, 117 patients in the LG group completed the procedure, and 113 in the RG group completed the procedure; these populations were defined as the per-protocol population.
• The overall incidence of postoperative complications of grade II or higher was significantly higher in the LG group.
• Even in an analysis limited to grade IIIa or higher, the complication rate was still significantly higher in the LG group.

Thus, the researchers concluded that this study found no reduction of intra-abdominal infectious complications with RG compared with LG for gastric cancer.

Reference:

Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer: A Randomized Clinical Trial by Toshiyasu Ojima et al. published in the JAMA surgery.

doi:10.1001/jamasurg.2021.3182