Robotic gastrectomy (RG) does not reduce postoperative complications associated with intra-abdominal infections compared with laparoscopic gastrectomy (LG) for gastric cancer, according to study results published in JAMA Surgery.

Comparative studies on the short-term and long-term outcomes of LG and RG are limited. In the current study, investigators sought to evaluate the benefits of RG over LG in reducing complications due to intra-abdominal infections.

Researchers conducted a phase 3, open-label, prospective superiority randomized clinical trial at 2 centers from April 1, 2018, to October 31, 2020. They compared the short-term surgical outcomes and long-term oncologic safety of RG vs LG in patients with gastric cancer. The primary outcome was the incidence of postoperative intra-abdominal infectious complications of Clavien-Dindo grade II or higher.


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The analysis included 241 patients randomly assigned to 2 groups to undergo LG or RG; 63.6% were men with a mean age of 70.8 years. The modified intention-to-treat population (mITTP) included 236 patients, of which LG was performed in 119 patients and RG in 117 patients. Finally, 117 and 113 patients completed LG and RG, respectively, and they were defined as the per-protocol population (PPP).

Results of the analysis showed no significant differences in the overall incidence of intra-abdominal infectious complications of Clavien-Dindo grade II or higher in both the LG (10 of 119 patients [8.4%] in the mITTP and 10 of 117 patients [8.5%] in the PPP) and RG (7 of 117 patients [6.0%] in the mITTP and 7 of 113 patients [6.2%] in the PPP) groups.

The overall incidence of postoperative complications of grade II or higher was significantly higher in the LG group (23 of 119 patients [19.3%] in the mITTP and 23 of 117 patients [19.7%] in the PPP) compared with the RG group (10 of 117 patients [8.5%] in the mITTP and 10 of 113 patients [8.8%] in the PPP) (P =.02).

In the analysis limited to grade IIIa or higher, clinically serious complications occurred in 19 of 117 patients (16.2%) in the LG group of the PPP and in 6 of 113 patients (5.3%) in the RG group of the PPP (P =.01).

Study limitations included lack of long-term oncologic outcome data, unblinded postoperative management, and a small sample size.

Investigators concluded, “contrary to expectation, there was no reduction of intra-abdominal infectious complications with RG compared with LG.”

Reference

Ojima T, Nakamura M, Hayata K, et al. Short-term outcomes of robotic gastrectomy vs laparoscopic gastrectomy for patients with gastric cancer: a randomized clinical trial. JAMA Surg. 2021;156(10):954-963. doi:10.1001/jamasurg.2021.3182