To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes. METHODS: This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided. RESULTS: The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups. CONCLUSION: Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Minimally invasive surgery for gastric cancer. A comparison between robotic, laparoscopic and open surgery / Parisi, Amilcare; Reim, Daniel; Borghi, Felice; Nguyen, Ninh T; Qi, Feng; Coratti, Andrea; Cianchi, Fabio; Cesari, Maurizio; Bazzocchi, Francesca; Alimoglu, Orhan; Gagnière, Johan; Pernazza, Graziano; D'Imporzano, Simone; Zhou, Yan Bing; Azagra, Juan Santiago; Facy, Olivier; Brower, Steven T; Jiang, Zhi Wei; Zang, Lu; Isik, Arda; Gemini, Alessandro; Trastulli, Stefano; Novotny, Alexander; Marano, Alessandra; Liu, Tong; Annecchiarico, Mario; Badii, Benedetta; Arcuri, Giacomo; Avanzolini, Andrea; Leblebici, Metin; Pezet, Denis; Cao, Shou Gen; Goergen, Martine; Zhang, Shu; Palazzini, Giorgio; D'Andrea, Vito; Desiderio, Jacopo. - In: WORLD JOURNAL OF GASTROENTEROLOGY. - ISSN 1007-9327. - STAMPA. - 23:13(2017), pp. 2376-2384. [10.3748/wjg.v23.i13.2376]

Minimally invasive surgery for gastric cancer. A comparison between robotic, laparoscopic and open surgery

PALAZZINI, Giorgio;D'ANDREA, Vito;Desiderio, Jacopo
2017

Abstract

To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes. METHODS: This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided. RESULTS: The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups. CONCLUSION: Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.
2017
Gastrectomy; castric cancer; laparoscopy; minimally invasive surgery; robot-assisted; robotic
01 Pubblicazione su rivista::01a Articolo in rivista
Minimally invasive surgery for gastric cancer. A comparison between robotic, laparoscopic and open surgery / Parisi, Amilcare; Reim, Daniel; Borghi, Felice; Nguyen, Ninh T; Qi, Feng; Coratti, Andrea; Cianchi, Fabio; Cesari, Maurizio; Bazzocchi, Francesca; Alimoglu, Orhan; Gagnière, Johan; Pernazza, Graziano; D'Imporzano, Simone; Zhou, Yan Bing; Azagra, Juan Santiago; Facy, Olivier; Brower, Steven T; Jiang, Zhi Wei; Zang, Lu; Isik, Arda; Gemini, Alessandro; Trastulli, Stefano; Novotny, Alexander; Marano, Alessandra; Liu, Tong; Annecchiarico, Mario; Badii, Benedetta; Arcuri, Giacomo; Avanzolini, Andrea; Leblebici, Metin; Pezet, Denis; Cao, Shou Gen; Goergen, Martine; Zhang, Shu; Palazzini, Giorgio; D'Andrea, Vito; Desiderio, Jacopo. - In: WORLD JOURNAL OF GASTROENTEROLOGY. - ISSN 1007-9327. - STAMPA. - 23:13(2017), pp. 2376-2384. [10.3748/wjg.v23.i13.2376]
File allegati a questo prodotto
File Dimensione Formato  
Parisi_Robotic-laparoscopic_2017.pdf

accesso aperto

Note: Articolo principale
Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Creative commons
Dimensione 2.23 MB
Formato Adobe PDF
2.23 MB Adobe PDF

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/951020
Citazioni
  • ???jsp.display-item.citation.pmc??? 19
  • Scopus 61
  • ???jsp.display-item.citation.isi??? 55
social impact