Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis

Background: To date, robotic surgery has been widely used worldwide. We conducted a systematic review and meta-analysis to evaluate short-term and long-term outcomes of robotic gastrectomy (RG) in gastric cancer patients to determine whether RG can replace laparoscopic gastrectomy (LG). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was applied to perform the study. Pubmed, Cochrane Library, WanFang, China National Knowledge Infrastructure (CNKI), and VIP databases were comprehensively searched for studies published before May 2020 that compared RG with LG. Next, two independent reviewers conducted literature screening and data extraction. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS), and the data analyzed using the Review Manager 5.3 software. Random effects or fixed effects models were applied according to heterogeneity. Results: A total of 19 studies including 7275 patients were included in the meta-analyses, of which 4598 patients were in the LG group and 2677 in the RG group. Compared with LG, RG was associated with longer operative time (WMD = -32.96, 95% CI -42.08 similar to -23.84, P < 0.001), less blood loss (WMD = 28.66, 95% CI 18.59 similar to 38.73, P < 0.001), and shorter time to first flatus (WMD = 0.16 95% CI 0.06 similar to 0.27, P = 0.003). There was no significant difference between RG and LG in terms of the hospital stay (WMD = 0.23, 95% CI -0.53 similar to 0.98, P = 0.560), overall postoperative complication (OR = 1.07, 95% CI 0.91 similar to 1.25, P = 0.430), mortality (OR = 0.67, 95% CI 0.24 similar to 1.90, P = 0.450), the number of harvested lymph nodes (WMD = -0.96, 95% CI -2.12 similar to 0.20, P = 0.100), proximal resection margin (WMD = -0.10, 95% CI -0.29 similar to 0.09, P = 0.300), and distal resection margin (WMD = 0.15, 95% CI -0.21 similar to 0.52, P = 0.410). No significant differences were found between the two treatments in overall survival (OS) (HR = 0.95, 95% CI 0.76 similar to 1.18, P = 0.640), recurrence-free survival (RFS) (HR = 0.91, 95% CI 0.69 similar to 1.21, P = 0.530), and recurrence rate (OR = 0.90, 95% CI 0.67 similar to 1.21, P = 0.500). Conclusions: The results of this study suggested that RG is as acceptable as LG in terms of short-term and long-term outcomes. RG can be performed as effectively and safely as LG. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of the robotic surgery for gastric cancer.