Lymphadenectomy in Robotic and Laparoscopic Gastrectomy – A Retrospective Study with Propensity Score Matching.
We retrospectively reviewed the medical records of 215 consecutive patients with gastric cancer who underwent RG or LG with D1+ or D2 lymphadenectomy at our institution between January 2011 and December 2020. Exclusion criteria were residual gastric cancer, proximal gastrectomy, and D1 lymphadenectomy. Propensity score matching analysis was performed to control selection bias by age, sex, body mass index, operation method, lymphadenectomy, and pathological stage. Of the total cohort, 34 matched pairs were selected. Comparisons between groups were performed using the Fisher’s exact test or Mann-Whitney U-test, as appropriate.
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In this retrospective cohort study, we collected data from consecutive patients with gastric cancer who underwent subtotal or total RG or LG with lymph node dissection at our institution between January 2011 and December 2020. In our institution, LG was introduced for the treatment of gastric cancer in January 2011, and RG using the da Vinci Si Surgical SystemTM (Intuitive Surgical, Sunnyvale, CA, USA) was initiated in December 2017. Since RG was introduced, all patients were informed about the advantages and disadvantages of RG and LG by the surgeon and were given a choice about the preferred surgical approach. This study was approved by the review board of our institution, and complied with the principles laid down in the Declaration of Helsinki. Informed consent was obtained from all eligible patients who agreed to participate. This research is being reported in line with the STROCSS 2019 Guideline. The exclusion criteria were as follows: (1) residual gastric cancer; (2) neoadjuvant chemotherapy; (3) conversion to open surgery before completion of lymph node dissection; (4) lymph node D1 dissection; (5) proximal gastrectomy; and (6) incomplete clinical data. Cases with residual gastric cancer were excluded because the pattern of lymphatic drainage was likely to have been modified by the initial surgery. Overall, 215 patients (44 who underwent RG and 171 who underwent LG) were eligible for analysis. The following patient characteristics were recorded: age, sex, body mass index (BMI), the American Society of Anesthesiologists Physical Status (ASA-PS). In all cases, gastric cancer diagnosis and staging was performed using thoracoabdominal contrast-enhanced computed tomography (CT), upper gastrointestinal endoscopy with biopsy, ultrasound endoscopy, and positron emission tomography (PET)-CT for advanced GC patients. Tumor staging was performed according to the Japanese classification of gastric carcinoma: 3rd English edition. Surgical complications were classified according to the Clavien–Dindo system. Postoperative pancreatic fistula was defined as an abdominal drainage fluid with amylase activity three times higher than the upper normal limit of the serum value; grading was based on the updated consensus of the International Study Group on Pancreatic Surgery.