Meta-Analysis
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World J Meta-Anal. Aug 26, 2014; 2(3): 98-106
Published online Aug 26, 2014. doi: 10.13105/wjma.v2.i3.98
Robot-assisted vs laparoscopy-assisted gastrectomy for gastric cancer: A meta-analysis based on 3518 subjects
Zhi-Dong Lin, Mao Liu, Dan Tang, Huan Li, Bai-Meng Zhang
Zhi-Dong Lin, Dan Tang, Bai-Meng Zhang, Department of General Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong Province, China
Mao Liu, Department of Cardiology, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong Province, China
Huan Li, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Author contributions: Lin ZD and Liu M contributed equally to this work; Lin ZD, Tang D and Zhang BM designed the research; Tang D, Li H and Liu M performed the research; Lin ZD and Liu M contributed analytic tools and analyzed the data; Lin ZD, Tang D, Liu M and Zhang BM wrote the paper; Lin ZD and Liu M contributed equally to this work.
Correspondence to: Dr. Zhi-Dong Lin, Department of General Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, No.52 Meihua East Rd, Zhuhai 519000, Guangdong Province, China. linzhidongtd@21cn.com
Telephone: +86-756-2528811 Fax: +86-756-2528333
Received: January 8, 2014
Revised: May 16, 2014
Accepted: June 10, 2014
Published online: August 26, 2014
Processing time: 259 Days and 15 Hours
Abstract

AIM: To compare the short-term clinical outcomes of robot-assisted gastrectomy (RAG) with laparoscopy-assisted gastrectomy (LAG) in gastric cancer patients.

METHODS: Articles were identified through a literature search of Pubmed, EMBASE, Scopus, Web of Science, Chinese National Knowledge Infrastructure and the Cochrane Library. Weighted mean differences (WMDs) and odds ratios (ORs) were selected as effect sizes for quantitative variables and qualitative variables, respectively. And 95%CIs were also calculated.

RESULTS: A total of 13 studies with 3518 patients were included. RAG was associated with longer operative time (WMD = 46.26 min, 95%CI: 31.89-60.63, P < 0.00001), less blood loss [WMD = -37.19 mL, 95%CI: -60.16-(-14.23), P = 0.002] and shorter postoperative hospital stay [WMD = -0.65 d, 95%CI: -1.24-(-0.05), P = 0.03] than LAG. No significant difference in the numbers of retrieved lymph nodes was found between the two groups (WMD = 1.46, 95%CI: -0.19-3.10, P = 0.08). There was no significant difference in mortality (OR = 1.55, 95%CI: 0.49-4.94, P = 0.45), overall complications (OR = 1.00, 95%CI: 0.80-1.26, P = 0.98), anastomosis leakage (OR = 1.02, 95%CI: 0.62-1.65, P = 0.95) and anastomosis stenosis rates (OR = 0.54, 95%CI: 0.18-1.57, P = 0.25).

CONCLUSION: RAG is effective and safe in the treatment of gastric cancer. RAG is a promising alternative to laparoscopic surgery. Long-term randomized controlled studies with large scale and improved designs are needed to further evaluate the long-term outcomes.

Keywords: Gastric cancer; Robot; Laparoscopy; Gastrectomy; Meta-analysis

Core tip: A total of 13 studies with 3518 patients were included in this meta-analysis. The results indicated that robot-assisted gastrectomy was associated with longer operative time (WMD = 46.26 min, 95%CI: 31.89, 60.63, P < 0.00001), less blood loss [WMD = -37.19 mL, 95%CI: -60.16-(-14.23), P = 0.002] and shorter postoperative hospital stay [WMD = -0.65 d, 95%CI: -1.24-(-0.05), P = 0.03] than laparoscopy-assisted gastrectomy. Robot-assisted gastrectomy is effective and safe in the treatment of gastric cancer and will be a promising alternative to laparoscopic surgery. Long-term randomized controlled studies with large scale and improved designs are needed to further evaluate the long-term outcomes.