Robot-assisted surgery for gastric cancer

Table 1 Summary of studies reporting use of robotic surgery for gastric cancer

Ref.	Year	Type of study	Type of surgery	Stage1	Type of resection	No. of patients
						Total	R	L	O
Patriti et al[21]	2008	CS	R	6 patients I, 6 patients II, 1 patient III	8 DG, 4 TG, 1 PG	13	13
Lee et al[22]	2011	CS	R	I	DG	12	12
D'Annibale et al[23]	2011	CS	R	17 patients I, 6 patients II, 1 patient III	11 TG, 13 DG	24	24
Isogaki et al[24]	2011	CS	R	N/A	46 DG, 14 TG, 1 PG	61	61
Kim et al[25]	2013	CS	R	11 patients I, 1 patient III	N/A	12	12
Liu et al[26]	2013	CS	R	26 patients I, 32 patients II, 46 patients III	38 DG, 54 TG, 12 PG	104	104
Park et al[27]	2013	CS	R	178 patients I, 22 patients II or more advanced	154 STG, 46 TG	200	200
Tokunaga et al[28]	2014	CS	R	IA	18 DG	18	18
Anderson et al[29]	2007	CS	R	Early GC	7 STG	7	7
Song et al[30]	2009	CS	R	Early GC	67 STG, 33 TG	100	100
Hur et al[31]	2010	CS	R	N/A	5 STG, 2 TG	7	7
Uyama et al[32]	2012	CS	R	18 patients IA, 7 patients IIA to IIIC	25 DG	25	25
Yu et al[33]	2012	CS	R	N/A	29 DG, 12 TG	41	41
Jiang et al[34]	2012	CS	R	24 patients I, 28 patients II, 68 patients III2	62 DG, 35 TG, 23 PG	120	120
Hyung et al[18]	2007	NC	R vs L	N/A	N/A	30	10	20
Song et al[19]	2009	NC	R vs L	R: 20 patients I, L: 37 patients I, 3 patients II	R: 20 DG, L: 40 DG	60	20	40
Pugliese et al[35]	2010	NC	R vs L	37 patients early GC, 33 patients advanced GC	64 STG	64	16	48
Woo et al[17]	2011	NC	R vs L	827 patients Ia or Ib	R: 172 DG, 62, 2 CT; L: 481 DG, 108 TG, 2 CT	827	236	591
Eom et al[36]	2012	NC	R vs L	R: 25 patients I, 3 patients II, 2 patients III, L: 56 patients I, 6 patients II	DG both groups	92	30	62
Park et al[37]	2012	NC	R vs L	R: 27 patients I, 3 patients II; L: 108 patients I, 11 patients II, 1 patient III	DG both groups	150	30	120
Yoon et al[38]	2012	NC	R vs L	R: 29 patients I, 7 patients II, L: 55 patients I, 7 patients II, 3 patients III	TG both groups	101	36	65
Kang et al[39]	2012	NC	R vs L	R: 82 patients I, 11 patients II, 7 patients III	R: 84 STG, 16 TG	382	100	282
Hyun et al[40]	2013	NC	R vs L	R: 30 patients I, 5 patients II, 3 patients III; L: 67 patients I, 9 patients II, 7 patients III	R: 29 DG, 9 TG; L: 65 DG, 18 TG	121	38	83
Noshiro et al[41]	2014	NC	R vs L	R: 18 patients I, 3 patients II-IV, L: 113 patients I, 47 patients II-IV	DG both groups	181	21	160
Han et al[42]	2014	NC	R vs L	R: 59 patients I, 8 patients II, 1 patient III, L: 66 patients I, 2 patients II	PPG both groups	136	68	68
Junfeng et al[43]	2014	NC	R vs L	R: 29 patients I, 36 patients II, 55 patients III, L: 115 patients I, 98 patients II, 181 patients III	R: 92 DG, 26 TG, 2 PG; L: 261 DG, 118 TG, 15 PG	510	120	394
Kim et al[44]	2014	NC	R vs L	R: 145 patients I, 27 patients II and III; L: 422 patients I, 59 patients II and III	N/A	653	172	481
Kim et al[45]	2010	NC	R vs L vs O	Lower than cT2N1M0	STG all groups	39	16	11	12
Huang et al[46]	2012	NC	R vs L vs O	R: 29 patients I, 7 patients II, 3 patients III; L: 55 patients I, 9 patients II, O: 198 patients I, 106 patients II, 282 patients III	R: 32 STG, 7 TG; L: 57 STG, 7 TG; O: 407 STG, 179 TG	689	39	64	586
Kim et al[47]	2012	NC	R vs L vs O	R: 3 patients 0, 350 patients I, 51 patients II, 32 patients III; L: 8 patients 0, 714 patients I, 96 patients II, 43 patients III, O: 28 patients 0, 2376 patients I, 823 patients II, 1313 patients III	R: 327 DG, 109 TG, L: 703 DG, 158 TG; O: 3309 DG, 1232 TG	5839	436	861	4542
Pernazza et al[48]	2006	NC	R vs O	R: 2 patients 0, 20 patients I, 12 patients II, 5 patients III, 6 patients IV	R: 21 DG, 24 TG	90	45	0	45
Caruso et al[49]	2011	NC	R vs O	R: 13 patients I, 9 patients II, 4 patients III, 3 patients IV, O: 57 patients I, 18 patients II, 33 patients III, 12 patients IV	R: 16 DG, 12 TG, 1 PG; O: 83 DG, 37 TG	149	29	0	120
Procopiuc et al[50]	2015	NC	R vs O	R: 9 patients II, 9 patients III, O: 15 patients II, 14 patients III	R: 7 DG, 10 TG, 1 PG; O: 6 DG, 23 TG	47	18		29

¹Data as reported by the authors from preoperative evaluation;

²Postoperatively obtained staging. CS: Clinical series; NC: Nonrandomized comparative study; R: Robotic surgery; L: Laparoscopic surgery; O: Open surgery; TG: Total gastrectomy; STG: Subtotal gastrectomy; DG: Distal gastrectomy; PG: Proximal gastrectomy; CT: Completion total gastrectomy; PPG: Pylorus-preserving gastrectomy; GC: Gastric cancer.

Table 2 Main operative outcomes in studies reporting use of robotic surgery for gastric cancer

Ref.	OP time (min)	Estimated blood loss (mL)	No. of harvested lymph nodes	Conversions
Patriti et al[21]	286	103	28.1	0
Lee et al[14]	253	135	46	0
D'Annibale et al[23]	267.5	30	28	0
Isogaki et al[24]	TG > DG 520 > 388	TG > DG 150 > 61.8	TG approximately equal DG 43 approximately equal 42	0
Kim et al[25]	234.7	46.4	42.4
Liu et al[26]	272.52	80.78	23.1	1.8
Park et al[27]	248.8	146.1	37.9	3.5
Tokunaga et al[28]	331.5	32.5	40	0
Anderson et al[29]	420	300	24	0
Song et al[30]	231.3	128.2	36.7	0
Hur et al[31]	205
Uyama et al[32]	361	51.8	44.3	0
Yu et al[33]	TG > DG 285 > 225	TG > DG 180 > 150	34.2	4.8
Jiang et al[34]	245	70	22.5
Hyung et al[18]	Initial L > R > Recent L 337 > 253 > 164	-	Recent L > R > Initial L 37.8 > 34 > 29.2	0
Song et al[19]	Initial L > R > Recent L 289.5 > 230 > 134 ss	R > Recent L 94.8 > 39.5	Recent L > R > Initial L 42.7 > 35.3 > 31.5	0
Pugliese et al[35]	R > L 344 > 235 ss	L > R 148 > 90 ss	L > R 31 > 25	L > R 3 > 2
Woo et al[17]	R > L 219.5 > 170.7 ss	L > R 147.9 > 91.6 ss	R > L 39 > 37.4	0 = 0
Eom et al[36]	R > L 229.1 > 189.4 ss	R > L 152.8 > 88.3	L > R 33.4 > 30.2
Park et al[37]	R > L 218 > 140 ss	R > L 75 > 60	R approximately equal L 34 approximately equal 35	0
Yoon et al[38]	R > L 305.8 > 210.2 ss		R > L 42.8 > 39.4
Kang et al[39]	R > L 202 > 173 ss	L > R 173.4 > 93.2 ss
Hyun et al[40]	R > L 234.4 > 220	R approximately equal L 131.3 approximately equal 130.4	R approximately equal L 32.8 approximately equal 32.6	0 = 0
Noshiro et al[41]	R > L 439 > 315 ss	L > R 115 > 96	R > L 44 > 40	R = L 0 = 0
Han et al[42]	R > L 258 > 193 ss		L > R 36.5 > 33.4	0
Junfeng et al[43]	R > L 234.8 > 221.3 ss	L > R 137.6 > 118.3 ss	R > L 34.6 > 32.7 ss
Kim et al[44]	R > L 206.4 > 167.1 ss	L > R 134.9 > 59.8 ss	R approximately equal L 37.3 approximately equal 36.8	R = L 0 = 0
Kim et al[45]	R > L > O 259.2 > 203.9 > 126.7 ss	O > L > R 78.8 > 44.7 > 30.3 ss	O > R > L 43.3 > 41.1 > 37.4	0 = 0
Huang et al[46]	R > L > O 430 > 350 > 320	O > L > R 400 > 100 > 50 ss	O > R > L 34 > 32 > 26
Kim et al[47]	R > L > O 226 > 176 > 158 ss	O > L > R 182 > 112 > 85	O > R > L 40.5 > 40.2 > 37.6 ss
Pernazza et al[48]	R > O 293.8 > 224.6		R 34.2
Caruso et al[49]	R > O 290 > 222	O > R 386.1 > 197.6	O > R 31.7 > 28
Procopiuc et al[50]	R > O 320.83 > 243.36 ss	O > R 564.62 > 208.26 ss	O > R 25 > 22	0

R: Robotic surgery; L: Laparoscopic surgery; O: Open surgery; TG: Total gastrectomy; DG: Distal gastrectomy; ss: Statistically significant.

Table 3 Main postoperative outcomes in studies reporting use of robotic surgery for gastric cancer

Ref.	Time to first flatus (d)	Time to oral feeding (d)	Postoperative hospital stay (d)	Morbidity (%)	Mortality (%)	Follow up time (mo)
Patriti et al[21]			11.2	41.4	0	12.2
Lee et al[22]	2.4	4.6	6.6	8.3	0
D'Annibale et al[23]		5	6	2	0	48
Isogaki et al[24]				4	1
Kim et al[25]			6	0	0
Liu et al[26]	2.5	4.1	6.2	11.8	0
Park et al[27]			8	19	1
Tokunaga et al[28]			8	22.22
Anderson et al[29]		4 (2-8)	4 (3-9)	14.3
Song et al[30]	2.9 ± 0.5	4.2	7.8	13	0
Hur et al[31]
Uyama et al[32]		3.56	12.1	8	0	11
Yu et al[33]	3.1	3.7		4.8	0	11
Jiang et al[34]			6.3	5	0
Hyung et al[18]	Recent L > Initial L > R 3.3 > 3.1 > 2.9	Initial L > Recent L > R 4.8 > 4.3 > 4	Initial L > R = Recent L 6.9 > 6 = 6
Song et al[19]	Recent L > Initial L = R 3.25 > 3 = 3	Initial L > Recent L > R 4.95 > 4.1 > 4	Initial L > Recent L > R 7.7 > 6.2 > 5.7	Recent L > Initial L = R 10 > 5 = 5
Pugliese et al[35]			R = L 10 = 10	L > R 12.5 > 6.2	R > L 6.2 > 2	53
Woo et al[17]			R > L 7.7 > 7 ss	L > R 13.7 > 11	R approximately equal L 0.3 approximately equal 0.4
Eom et al[36]	R = L 3.4 = 3.4		R approximately equal L 7.9 approximatelyequal 7.8	R > L 13 > 6
Park et al[37]				R > L 17 > 7.5	R = L 0 = 0
Yoon et al[38]	L > R 4.9 > 4.2		L > R 10.3 > 8.8	R > L 16.7 > 15.4
Kang et al[39]			R > L 9.8 > 8.1 ss	R > L 14 > 10.3	R = L 0 = 0
Hyun et al[40]			L > R 11.9 > 10.5	R > L 47.3 > 38.5	R = L 0 = 0
Noshiro et al[41]			L > R 13 > 8 ss	L > R 10 > 9.5	0
Han et al[42]		L > R 5 > 4.4	L > R 9.1 > 8.6	L > R 22.1 > 19.1	R = L 0 = 0	R > L 22.7 > 19.3
Junfeng et al[43]	L > R 3.3 > 3.1	L > R 4.1 > 3.9	L approximately equal R 7.9 approximately equal 7.8	R > L 5.8 > 4.3	R > L 32.2 > 30.1	L > R 19 > 15
Kim et al[44]			R > L 7.1 > 6.7	R > L 5.2 > 4.2	L > R 0.6 > 0
Kim et al[45]	L > O > R 3.6 > 3.4 > 3.2		O > L > R 6.7 > 6.5 > 5.1 ss		R = L 0 = 0
Huang et al[46]				L > R > O 15.6 > 15.4 > 14.7
Kim et al[47]		O > L > R 5.7 > 4.7 > 4.4 ss	O > L > R 10.2 > 7.8 > 7.5 ss	O > R > L 10.7 > 10.1 > 934	0.4 ND
Pernazza et al[48]				R > O 24.5 > 13.3	O > R 8.9 > 4.4	R = O 26 = 26
Caruso et al[49]			O > R 13.4 > 9.6	O > R 42.5 > 41.4	O > R 3.3 > 0	O > R 44 > 25
Procopiuc et al[50]			O > R 11.04 > 8.1 ss	O > R 27.58 > 22.22	O = R 0 = 0	O > R 31.6 > 24.7

R: Robotic surgery; L: Laparoscopic surgery; O: Open surgery; TG: Total gastrectomy; DG: Distal gastrectomy; ss: Statistically significant; ND: No statistical difference.