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©The Author(s) 2017.
World J Gastroenterol. Apr 7, 2017; 23(13): 2376-2384
Published online Apr 7, 2017. doi: 10.3748/wjg.v23.i13.2376
Published online Apr 7, 2017. doi: 10.3748/wjg.v23.i13.2376
Table 1 Characteristics of patients n (%)
| Open | Laparoscopy | Robotic | P value | |
| Total | 302 | 151 | 151 | |
| Age | 67.19 ± 13.1 | 65.82 ± 14.16 | 68.81 ± 12.12 | 0.14 |
| BMI | 24.33 ± 3.65 | 24.02 ± 2.22 | 24.58 ± 3.00 | 0.31 |
| Sex | 0.26 | |||
| Female | 117 (38.7) | 66 (43.7) | 70 (46.4) | |
| Man | 185 (61.3) | 85 (56.3) | 81 (53.6) | |
| ASA | 0.18 | |||
| I | 66 (21.9) | 23 (15.2) | 26 (17.2) | |
| II | 139 (46.0) | 64 (42.4) | 73 (48.3) | |
| III | 97 (32.1) | 64 (42.4) | 52 (34.4) | |
| Comorbidities | 192 (63.6) | 96 (63.6) | 95 (62.9) | 0.96 |
Table 2 Details of surgical procedures and tumour pathology n (%)
| Open | Laparoscopy | Robotic | P value | |
| Type of gastrectomy | 0.42 | |||
| Distal | 205 (67.9) | 102 (67.5) | 111 (73.5) | |
| Total | 97 (32.1) | 49 (32.5) | 40 (26.5) | |
| Type of reconstruction | 0.10 | |||
| Billroth I/II | 88 (29.1) | 31 (20.5) | 51 (33.8) | |
| Roux-en-Y G-J | 117 (38.7) | 70 (46.4) | 60 (39.7) | |
| Roux-en-Y E-J | 97 (32.1) | 50 (33.1) | 40 (26.5) | |
| D2 Lymphadenectomy | 294 (97.4) | 144 (95.4) | 143 (94.7) | 0.32 |
| Position | 0.57 | |||
| Lower third | 153 (50.7) | 76 (50.3) | 84 (55.6) | |
| Middle third | 108 (35.8) | 54 (35.8) | 54 (35.8) | |
| Upper third | 41 (13.6) | 21 (13.9) | 13 (8.6) | |
| Pathologic stage | 0.16 | |||
| 0 | 19 (6.3) | 4 (2.6) | 4 (2.6) | |
| IA | 76 (25.2) | 54 (35.8) | 54 (35.8) | |
| IB | 48 (15.9) | 27 (17.9) | 27 (17.9) | |
| IIA | 55 (18.2) | 14 (9.3) | 14 (9.3) | |
| IIB | 28 (9.3) | 14 (9.3) | 14 (9.3) | |
| IIIA | 24 (7.9) | 12 (7.9) | 12 (7.9) | |
| IIIB | 34 (11.3) | 17 (11.3) | 17 (11.3) | |
| IIIC | 18 (6) | 9 (6) | 9 (6) | |
| Undifferentiated carcinoma | 115 (38.1) | 65 (43.0) | 55 (36.4) | 0.46 |
Table 3 Surgical and post-operative clinical outcomes n (%)
| Open | Laparoscopy | Robotic | P value | |
| Operative time (min) | 198.67 ± 59.66 | 220.37 ± 91.89 | 365.44 ± 80.92 | < 0.0001 |
| EBL (mL) | 127.26 ± 79.50 | 95.93 ± 119.22 | 117.91 ± 68.11 | 0.002 |
| LN retrieved | 25.82 ± 12.07 | 24.58 ± 13.56 | 27.78 ± 11.45 | 0.07 |
| R0 resections | 287 (95.0) | 145 (96.0) | 148 (98.0) | 0.59 |
| Intraoperative blood transfusion | 9 (3) | 7 (4.6) | 4 (2.6) | 0.56 |
| Intraoperative complications | 5 (1.7) | 3 (2) | 2 (1.3) | 0.9 |
| Hospital stay (d) | 12.68 ± 5.88 | 9.07 ± 9.16 | 8.85 ± 5.82 | < 0.0001 |
| Mobilization (d) | 2.36 ± 1.34 | 2.7 ± 1.51 | 1.42 ± 1.27 | < 0.0001 |
| Liquid diet (d) | 5.79 ± 3.30 | 4.12 ± 3.37 | 3.21 ± 2.49 | < 0.0001 |
| Soft solid diet (d) | 8.36 ± 5.45 | 5.73 ± 7.00 | 4.23 ± 3.79 | < 0.0001 |
| Resumption of peristalsis (d) | 2.64 ± 0.67 | 2.52 ± 0.68 | 2.35 ± 1.16 | 0.003 |
| First flatus (d) | 4.01 ± 1.05 | 3.75 ± 0.76 | 3.23 ± 1.33 | < 0.0001 |
| Drain removal (d) | 8.5 ± 3.55 | 6.44 ± 4.61 | 6.05 ± 8.69 | < 0.0001 |
| NG removal (d) | 4.92 ± 1.88 | 3.98 ± 1.74 | 2.82 ± 2.01 | < 0.0001 |
| Intravenous antibiotic use (d) | 6.13 ± 3.84 | 4.58 ± 3.52 | 3.92 ± 4.27 | < 0.0001 |
| Intravenous analgesic use (d) | 3.79 ± 1.48 | 2.9 ± 0.91 | 3.44 ± 1.78 | < 0.0001 |
| Post-operative transfusion | 19 (6.3) | 13 (8.6) | 13 (8.6) | 0.56 |
| Complications (patients) | 59 (19.5) | 18 (11.9) | 27 (17.9) | 0.13 |
Table 4 Analysis of post-operative complications n (%)
| Type of complication | Open | Laparoscopy | Robotic | Total |
| Anastomotic stenosis | 1 | 1 | 1 | 3 |
| Arrhythmias | 1 | 1 | 2 | 4 |
| Cerebral vascular accident | 0 | 0 | 1 | 1 |
| Congestive heart failure | 1 | 0 | 0 | 1 |
| Delayed gastric emptying | 3 | 0 | 0 | 3 |
| Dumping syndrome | 3 | 0 | 0 | 3 |
| Fluid collection/abscess | 4 | 1 | 0 | 5 |
| Intestinal obstruction | 2 | 3 | 0 | 5 |
| Intra-abdominal bleeding | 2 | 0 | 4 | 6 |
| Intraluminal bleeding | 3 | 2 | 3 | 8 |
| Leak | 11 | 4 | 4 | 19 |
| Myocardial infarction | 2 | 0 | 0 | 2 |
| Pancreatic fistula | 2 | 0 | 4 | 6 |
| Peritonitis | 1 | 0 | 0 | 0 |
| Pleural effusion | 3 | 0 | 0 | 3 |
| Pneumonia | 8 | 1 | 4 | 13 |
| Pulmonary edema | 1 | 0 | 0 | 1 |
| Pulmonary embolism | 0 | 0 | 1 | 1 |
| Remnant stomach necrosis | 0 | 1 | 0 | 1 |
| Sepsis | 4 | 0 | 1 | 5 |
| Urinary | 3 | 3 | 0 | 6 |
| Wound infection | 0 | 1 | 0 | 1 |
| Other | 13 | 1 | 2 | 16 |
| Total no. of complications | 68 | 19 | 30 | 117 |
| Non-surgical related | 32 (47.1) | 6 (31.6) | 10 (33.3) | 48 (41.03) |
| Surgical-related | 36 (52.9) | 13 (68.4) | 20 (66.7) | 69 (58.97) |
| Clavien dindo grade | ||||
| I + II | 50 (73.5) | 12 (63.2) | 28 (93.3) | 90 (76.9) |
| IIIa | 3 (4.4) | 2 (10.5) | 0 (0.0) | 5 (4.3) |
| IIIb | 11 (16.2) | 5 (26.3) | 2 (5.7) | 18 (15.4) |
| IV | 4 (5.9) | 0 (0.0) | 0 (0.0) | 4 (3.4) |
| Leakage rate | 11 (3.6) | 4 (2.6) | 4 (2.6) | |
| Reoperation | 11 (3.6) | 5 (3.3) | 2 (1.3) | |
| Analysis of leakage | ||||
| Leakage rate | 11 (3.6) | 4 (2.6) | 4 (2.6) | |
| Site of leak | ||||
| Duodenal stump | 4 | 1 | 2 | 7 |
| Esophagojejunostomy | 4 | 3 | 0 | 7 |
| Gastroduodenostomy | 1 | 0 | 0 | 1 |
| Gastrojejunostomy | 2 | 0 | 2 | 4 |
| Leak-related reoperation | 5 (1.7) | 2 (1.3) | 0 (0.0) |
- Citation: Parisi A, Reim D, Borghi F, Nguyen NT, Qi F, Coratti A, Cianchi F, Cesari M, Bazzocchi F, Alimoglu O, Gagnière J, Pernazza G, D’Imporzano S, Zhou YB, Azagra JS, Facy O, Brower ST, Jiang ZW, Zang L, Isik A, Gemini A, Trastulli S, Novotny A, Marano A, Liu T, Annecchiarico M, Badii B, Arcuri G, Avanzolini A, Leblebici M, Pezet D, Cao SG, Goergen M, Zhang S, Palazzini G, D’Andrea V, Desiderio J. Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery. World J Gastroenterol 2017; 23(13): 2376-2384
- URL: https://www.wjgnet.com/1007-9327/full/v23/i13/2376.htm
- DOI: https://dx.doi.org/10.3748/wjg.v23.i13.2376