Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2020; 26(11): 1172-1184
Published online Mar 21, 2020. doi: 10.3748/wjg.v26.i11.1172
Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis
Susumu Shibasaki, Koichi Suda, Masaya Nakauchi, Kenichi Nakamura, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama
Susumu Shibasaki, Koichi Suda, Masaya Nakauchi, Kenichi Nakamura, Kazuki Inaba, Ichiro Uyama, Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
Koichi Suda, Kenji Kikuchi, Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
Author contributions: Shibasaki S, Suda K, and Uyama I made substantial contributions to conception and design of the study; Shibasaki S, Nakauchi M, Nakamura K, Kikuchi K, and Inaba K contributed to acquisition, analysis, or interpretation of the data; Shibasaki S and Nakauchi M performed the statistical analysis; Shibasaki S, Suda K, and Uyama I drafted the article and made critical revisions related to important intellectual content of the manuscript; all the authors have read and approved the final version to be published.
Informed consent statement: Informed consent was obtained from all patients.
Institutional review board statement: This study was approved by the institutional review board of Fujita Health University.
Conflict-of-interest statement: All the authors except for I. U. have no commercial association with or financial involvement that might pose a conflict of interest in connection with the submitted article. I. U. has received lecture fees from Intuitive Surgical, Inc.. K. S. and K. K. have been funded by Medicaroid, Inc. in relation to Collaborative Laboratory for Research and Development in Advanced Surgical Technology. K.S. has also received advisory fees from Medicaroid, Inc. outside of the submitted work.
STROBE statement: Authors have read the STROBE Statement checklist of items and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Koichi Suda, FACS, MD, PhD, Professor, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Aichi, Japan. ko-suda@nifty.com
Received: November 15, 2019
Peer-review started: November 15, 2019
First decision: February 14, 2019
Revised: March 5, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: March 21, 2020
Processing time: 126 Days and 11.7 Hours
Abstract
BACKGROUND

Minimally invasive surgery for gastric cancer (GC) has gained widespread use as a safe curative procedure especially for early GC.

AIM

To determine risk factors for postoperative complications after minimally invasive gastrectomy for GC.

METHODS

Between January 2009 and June 2019, 1716 consecutive patients were referred to our division for primary GC. Among them, 1401 patients who were diagnosed with both clinical and pathological Stage III or lower GC and underwent robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) were enrolled. Retrospective chart review and multivariate analysis were performed for identifying risk factors for postoperative morbidity.

RESULTS

Morbidity following minimally invasive gastrectomy was observed in 7.5% of the patients. Multivariate analyses demonstrated that non-robotic minimally invasive surgery, male gender, and an operative time of ≥ 360 min were significant independent risk factors for morbidity. Therefore, morbidity was compared between RG and LG. Accordingly, propensity-matched cohort analysis revealed that the RG group had significantly fewer intra-abdominal infectious complications than the LG group (2.5% vs 5.9%, respectively; P = 0.038), while no significant differences were noted for other local or systemic complications. Multivariate analyses of the propensity-matched cohort revealed that non-robotic minimally invasive surgery [odds ratio = 2.463 (1.070–5.682); P = 0.034] was a significant independent risk factor for intra-abdominal infectious complications.

CONCLUSION

The findings showed that robotic surgery might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.

Keywords: Stomach neoplasms; Gastrectomy; Robotic surgical procedure; Minimally invasive procedures; Morbidity; Pancreatic fistula

Core tip: This study aimed to determine risk factors for postoperative complications after minimally invasive gastrectomy for gastric cancer. Accordingly, multivariate analysis identified non-robotic minimally invasive surgery as an independent risk factor for postoperative complications. Propensity score matching analysis showed that the robotic gastrectomy group had a significantly lower incidence of intra-abdominal infectious complications compared to the laparoscopic gastrectomy group. Additionally, multivariate analyses in the propensity score-matched cohort showed that non-robotic minimally invasive surgery was a significant independent risk factor for intra-abdominal infectious complications.