Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma

Hyoung Il Kim, Sang Uk Han, Han Kwang Yang, Young Woo Kim, Hyuk Joon Lee, Keun Won Ryu, Joong Min Park, Ji Yeong An, Min Chan Kim, Sungsoo Park, Kyo Young Song, Sung Jin Oh, Seong Ho Kong, Byoung Jo Suh, Dae Hyun Yang, Tae Kyung Ha, Youn Nam Kim, Woo Jin Hyung

Research output: Contribution to journalArticle

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Abstract

Objective: To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. Background: Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy. Methods: A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis. Results: A total of 434 patients were enrolled for treatment with either robotic (n=223) or laparoscopic (n=211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n=185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In perprotocol analysis, both group s showed similar overall complication rates (robotic=11.9% vs laparoscopic=10.3%) and major complication rates (robotic=1.1% vs laparoscopic=1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic=221 minutes vs laparoscopic=178 minutes; P<0.001) and significantly higher total costs (robotic=US$13,432 vs laparoscopic=US$8090; P<0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay. Conclusions: The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.

Original languageEnglish
Pages (from-to)103-109
Number of pages7
JournalAnnals of surgery
Volume263
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1

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Robotics
Gastrectomy
Stomach
Adenocarcinoma
Prospective Studies
Length of Stay
Costs and Cost Analysis
Intention to Treat Analysis
Minimally Invasive Surgical Procedures
Mortality
Operative Time
Laparoscopy
Multicenter Studies
Stomach Neoplasms
Therapeutics
Clinical Trials
Diet
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Kim, Hyoung Il ; Han, Sang Uk ; Yang, Han Kwang ; Kim, Young Woo ; Lee, Hyuk Joon ; Ryu, Keun Won ; Park, Joong Min ; An, Ji Yeong ; Kim, Min Chan ; Park, Sungsoo ; Song, Kyo Young ; Oh, Sung Jin ; Kong, Seong Ho ; Suh, Byoung Jo ; Yang, Dae Hyun ; Ha, Tae Kyung ; Kim, Youn Nam ; Hyung, Woo Jin. / Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. In: Annals of surgery. 2016 ; Vol. 263, No. 1. pp. 103-109.
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abstract = "Objective: To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. Background: Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy. Methods: A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis. Results: A total of 434 patients were enrolled for treatment with either robotic (n=223) or laparoscopic (n=211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n=185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In perprotocol analysis, both group s showed similar overall complication rates (robotic=11.9{\%} vs laparoscopic=10.3{\%}) and major complication rates (robotic=1.1{\%} vs laparoscopic=1.1{\%}) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic=221 minutes vs laparoscopic=178 minutes; P<0.001) and significantly higher total costs (robotic=US$13,432 vs laparoscopic=US$8090; P<0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay. Conclusions: The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.",
author = "Kim, {Hyoung Il} and Han, {Sang Uk} and Yang, {Han Kwang} and Kim, {Young Woo} and Lee, {Hyuk Joon} and Ryu, {Keun Won} and Park, {Joong Min} and An, {Ji Yeong} and Kim, {Min Chan} and Sungsoo Park and Song, {Kyo Young} and Oh, {Sung Jin} and Kong, {Seong Ho} and Suh, {Byoung Jo} and Yang, {Dae Hyun} and Ha, {Tae Kyung} and Kim, {Youn Nam} and Hyung, {Woo Jin}",
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Kim, HI, Han, SU, Yang, HK, Kim, YW, Lee, HJ, Ryu, KW, Park, JM, An, JY, Kim, MC, Park, S, Song, KY, Oh, SJ, Kong, SH, Suh, BJ, Yang, DH, Ha, TK, Kim, YN & Hyung, WJ 2016, 'Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma', Annals of surgery, vol. 263, no. 1, pp. 103-109. https://doi.org/10.1097/SLA.0000000000001249

Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. / Kim, Hyoung Il; Han, Sang Uk; Yang, Han Kwang; Kim, Young Woo; Lee, Hyuk Joon; Ryu, Keun Won; Park, Joong Min; An, Ji Yeong; Kim, Min Chan; Park, Sungsoo; Song, Kyo Young; Oh, Sung Jin; Kong, Seong Ho; Suh, Byoung Jo; Yang, Dae Hyun; Ha, Tae Kyung; Kim, Youn Nam; Hyung, Woo Jin.

In: Annals of surgery, Vol. 263, No. 1, 01.01.2016, p. 103-109.

Research output: Contribution to journalArticle

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T1 - Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma

AU - Kim, Hyoung Il

AU - Han, Sang Uk

AU - Yang, Han Kwang

AU - Kim, Young Woo

AU - Lee, Hyuk Joon

AU - Ryu, Keun Won

AU - Park, Joong Min

AU - An, Ji Yeong

AU - Kim, Min Chan

AU - Park, Sungsoo

AU - Song, Kyo Young

AU - Oh, Sung Jin

AU - Kong, Seong Ho

AU - Suh, Byoung Jo

AU - Yang, Dae Hyun

AU - Ha, Tae Kyung

AU - Kim, Youn Nam

AU - Hyung, Woo Jin

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective: To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. Background: Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy. Methods: A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis. Results: A total of 434 patients were enrolled for treatment with either robotic (n=223) or laparoscopic (n=211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n=185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In perprotocol analysis, both group s showed similar overall complication rates (robotic=11.9% vs laparoscopic=10.3%) and major complication rates (robotic=1.1% vs laparoscopic=1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic=221 minutes vs laparoscopic=178 minutes; P<0.001) and significantly higher total costs (robotic=US$13,432 vs laparoscopic=US$8090; P<0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay. Conclusions: The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.

AB - Objective: To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. Background: Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy. Methods: A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis. Results: A total of 434 patients were enrolled for treatment with either robotic (n=223) or laparoscopic (n=211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n=185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In perprotocol analysis, both group s showed similar overall complication rates (robotic=11.9% vs laparoscopic=10.3%) and major complication rates (robotic=1.1% vs laparoscopic=1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic=221 minutes vs laparoscopic=178 minutes; P<0.001) and significantly higher total costs (robotic=US$13,432 vs laparoscopic=US$8090; P<0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay. Conclusions: The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.

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