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

Background: Advanced minimally invasive techniques including robotic surgery are being employed with increasing frequency around the world, primarily in order to improve the surgical outcomes of laparoscopic gastrectomy (LG). We conducted a systematic review and meta-analysis to evaluate the feasibility, safety and efficacy of robotic gastrectomy (RG). Methods: Studies, which compared surgical outcomes between LG and RG, were retrieved from medical databases before May 2017. Outcomes of interest were estimated as weighted mean difference (WMD) or risk ratio (RR) using the random-effects model. The software Review Manage version 5.1 was used for all calculations. Results: Nineteen comparative studies with 5953 patients were included in this analysis. Compared with LG, RG was associated with longer operation time (WMD = -49.05 min; 95% CI: -58.18 similar to -39.91, P < 0.01), less intraoperative blood loss (WMD = 24.38 ml; 95% CI: 12.32 similar to 36.43, P < 0.01), earlier time to oral intake (WMD = 0.23 days; 95% CI: 0.13 similar to 0.34, P < 0.01), and a higher expense (WMD = -3944.8 USD; 95% CI: -4943.5 similar to -2946.2, P < 0.01). There was no significant difference between RG and LG regarding time to flatus, hospitalization, morbidity, mortality, harvested lymph nodes, and cancer recurrence. Conclusions: RG can be performed as safely as LG. However, it will take more effort to decrease operation time and expense.