Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma

Objective: To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. Background: Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy. Methods: A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis. Results: A total of 434 patients were enrolled for treatment with either robotic (n=223) or laparoscopic (n=211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n=185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In perprotocol analysis, both group s showed similar overall complication rates (robotic=11.9% vs laparoscopic=10.3%) and major complication rates (robotic=1.1% vs laparoscopic=1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic=221 minutes vs laparoscopic=178 minutes; P<0.001) and significantly higher total costs (robotic=US$13,432 vs laparoscopic=US$8090; P<0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay. Conclusions: The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.