Robotic gastrectomy (RG) is not associated with a reduction in intra-abdominal infectious complications compared with laparoscopic gastrectomy (LG) in patients with gastric cancer, according to a study in JAMA Surgery.
The phase 3, open-label, randomized controlled trial was conducted at 2 centers from April 1, 2018, to October 31, 2020. Investigators compared the short-term surgical and long-term oncologic safety of RG vs LG for patients with gastric cancer. The incidence of postoperative intra-abdominal infectious complications of Clavien-Dindo grade ≥2 was the primary endpoint.
The study included 241 patients (mean age, 70.8 years; SD, 10.7 years; 63.6% men). LG was conducted in 119 patients and RG in 117 patients. These populations were defined as the modified intention-to-treat population (mITTP). Ultimately, 117 patients completed LG, and 113 completed RG and were defined as the per-protocol population (PPP).
No significant differences were reported in the overall incidence of intra-abdominal infectious complications in the LG group (10 of 119 patients [8.4%] in the mITTP and 10 of 117 patients [8.5%] in the PPP) or in the RG group (7 of 117 patients [6.0%] in the mITTP and 7 of 113 patients [6.2%] in the PPP).
The investigators found that the overall incidence of postoperative complications of grade 2 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) vs the RG group (10 of 117 patients [8.5%] in the mITTP and 10 of 113 patients [8.8%] in the PPP) (P =.02).
Clinically serious complications of grade 3a or higher 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). No differences were observed in surgical and medical complications in comparisons for each subtype of complication.
The study has several limitations, including lack of analysis of long-term oncologic outcomes. Additionally, blinding was not applied regarding postoperative management of the patients. Finally, due to the relatively small sample size, subgroup analyses would decrease statistical power.
“[C]ontrary to expectation, there was no reduction of intra-abdominal infectious complications with RG compared with LG,” stated the researchers.
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. Published online September 1, 2021. doi: 10.1001/jamasurg.2021.3182