Outcomes of Gastric Resection in the Establishment of a Comprehensive Oncologic Robotic Program

J Surg Res. 2020 Aug;252:30-36. doi: 10.1016/j.jss.2020.01.023. Epub 2020 Mar 26.

Abstract

Background: Robotic-assisted gastrectomy is increasingly utilized for the treatment of gastric malignancies. However, the benefits of robotic surgery have been questioned. This study describes short-term outcomes in the establishment of a comprehensive robotic program for gastric malignancies.

Materials and methods: Patients who underwent robotic-assisted gastric resections between 2013 and 2018 were studied. Preoperative measures and surgical outcomes were analyzed. Finally we studied and analyzed robotic and open gastrectomy for the management of gastric adenocarcinoma (GC) at the same institution between 2000 and 2018 for quality benchmarking.

Results: Forty six patients (pts.) underwent robotic-assisted gastric resections. 26 (56.5%) were male, with a median age of 62 y (range: 29-87). Pathology included GC, gastrointestinal stromal tumors, neuroendocrine tumors, metastatic lesions, and benign processes. 19 pts. underwent total gastrectomy, 16 distal gastrectomy, four subtotal gastrectomy, and seven wedge resection. Pts. undergoing distal gastrectomy and wedge resection experienced shorter operative times and length of stay than total gastrectomy (P < 0.01; P < 0.01). Four operations (8.8%) were converted to open and 13 pts (28.3%) had postoperative complications, including an 8.7% readmission rate. Median lymph nodes retrieved during total, subtotal, and distal gastrectomy were 20 (13-46), 12.5 (0-26), and 16.5 (0-34), respectively. All pts. underwent margin negative resection. Median follow-up for GC was 21 mo, and 60% of pts. received adjuvant therapy at a median of 59d (range: 23-106).

Conclusions: Robotic gastrectomy is a feasible alternative to open gastrectomy. Our results will help establish benchmarks to improve perioperative outcomes, especially length of stay and time to initiation of therapy.

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Chemotherapy, Adjuvant / statistics & numerical data
  • Conversion to Open Surgery / statistics & numerical data
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Gastrectomy / adverse effects*
  • Gastrectomy / methods
  • Humans
  • Kaplan-Meier Estimate
  • Length of Stay / statistics & numerical data
  • Lymph Node Excision / methods
  • Lymph Node Excision / statistics & numerical data
  • Lymph Nodes / pathology
  • Male
  • Margins of Excision
  • Middle Aged
  • Neoplasm Staging
  • Operative Time
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Robotic Surgical Procedures / adverse effects*
  • Stomach / pathology
  • Stomach / surgery
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / therapy*
  • Time-to-Treatment