Recurrence outcomes of robotic-versus laparoscopic-assisted gastrectomy for gastric cancer:a multi-center propensity score-matched cohort study
Objective To compare and evaluate recurrence patterns after robotic-assisted gastrectomy(RAG)versus laparoscopic-assisted gastrectomy(LAG).Methods This was a retrospective cohort study of 2915 consecutive patients with gastric adenocarcinoma confirmed by postoperative histology as T1-4aN0-3M0,who had undergone minimally invasive radical gastrectomy at four large gastric cancer treatment centers(Fujian Medical University Union Hospital:1426 patients;the First Affiliated Hospital,Nanchang University:1108;Tianjin Medical University Cancer Institute and Hospital:196;and First Affiliated Hospital of Xi'an Jiaotong University:185 cases)between 1 January 2015 and 30 June 2019.930 patients had undergone RAG(RAG group)and 1985 had undergone LAG(LAG group).We assessed the following characteristics:age,sex,body mass index,American Society of Anesthesiologists score,comorbidities,tumor size,extent of surgery,extent of lymph node dissection,pT,pN,year of surgery,and adjuvant chemotherapy,after propensity score matching(1:1).There were no significant differences in baseline clinical characteristics between the two groups formed by propensity score matching(837 in each group)(all P＞0.05).The 3-year recurrence-free survival(RFS),recurrence pattern,and conditional RFS were compared.Results We detected no significant differences in the overall recurrence rate at 3 years(128/837[15.3％]vs.141/837[16.8％],P=0.387)or time to recurrence(15.7±8.1 months vs.16.4±8.4 months,P=0.449)between the RAG and LAG groups.Peritoneal recurrence was the most common type of recurrence in both groups(55[6.6％]vs.69[8.2％],P=0.524).The difference in 3-year RFS between the RAG and LAG groups was not statistically significant(83.2％vs.82.5％,P=0.781).We found that age＞60 years,total gastrectomy,and worse pT stage and pN stage were independent risk factors for recurrence in the study patients(all P＜0.05),whereas the surgical procedure(RAG or LAG)was not an independent risk factor for RFS(P=0.242).The 3-year conditional RFS at various time points was comparable between the two groups(1 year postoperatively:84.6％vs.84.7％,P=0.793;3 years postoperatively:91.5％vs.94.9％,P=0.647).Conclusions In this multicenter study of patients with locally resectable gastric cancer,we demonstrated that RAG performed by surgeons at large gastric cancer centers is not inferior to LAG in 3-year recurrence rate or recurrence patterns.
万方数据
维普
