Clinical efficacy and safety of robotic distal gastrectomy for gastric cancer: a systematic review and meta-analysis

Background Robotic distal gastrectomy (RDG) is a new technique that is rapidly gaining popularity and may help overcome the limitations of laparoscopic distal gastrectomy (LDG); however, its safety and therapeutic efficacy remain controversial. Therefore, this meta-analysis was performed to evaluate the safety and efficacy of RDG. Methods We searched PubMed, EMBASE, the Cochrane Library, and Web of Science for studies that compared RDG and LDG and were published between the time of database inception and May 2021. We assessed the bias risk of the observational studies using ROBIN-I, and a random effect model was always applied. Results The meta-analysis included 22 studies involving 5386 patients. Compared with LDG, RDG was associated with longer operating time (Mean Difference [MD] = 43.88, 95% CI = 35.17-52.60), less intraoperative blood loss (MD = - 24.84, 95% CI = - 41.26 to - 8.43), a higher number of retrieved lymph nodes (MD = 2.41, 95% CI = 0.77-4.05), shorter time to first flatus (MD = - 0.09, 95% CI = - 0.15 to - 0.03), shorter postoperative hospital stay (MD = - 0.68, 95% CI = - 1.27 to - 0.08), and lower incidence of pancreatic fistula (OR = 0.23, 95% CI = 0.07-0.79). Mean proximal and distal resection margin distances, time to start liquid and soft diets, and other complications were not significantly different between RDG and LDG groups. However, in the propensity-score-matched meta-analysis, the differences in time to first flatus and postoperative hospital stay between the two groups lost significance. Conclusions Based on the available evidence, RDG appears feasible and safe, shows better surgical and oncological outcomes than LDG and, comparable postoperative recovery and postoperative complication outcomes.

Automated summary

This meta-analysis evaluated the safety and efficacy of robotic distal gastrectomy (RDG). The analysis included 22 studies with 5386 patients. The results showed that compared to laparoscopic distal gastrectomy (LDG), RDG had longer operating time, less intraoperative blood loss, more retrieved lymph nodes, shorter time to first flatus, shorter postoperative hospital stay, and lower incidence of pancreatic fistula. However, there were no significant differences in other parameters between RDG and LDG groups. Propensity-score-matched analysis showed that the differences in time to first flatus and postoperative hospital stay between the two groups lost significance.