Song Jeong Ho, Boo Yeojin, Son Sang-Yong, Hur Hoon, Han Sang-Uk, Association And Information Committee Of The Korean Gastric Cancer
Department of Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
Chin J Cancer Res. 2025 Apr 30;37(2):200-211. doi: 10.21147/j.issn.1000-9604.2025.02.07.
The Safety of robotic gastrectomy (RG) compared to laparoscopic gastrectomy (LG) for gastric cancer remains uncertain on a national scale, with limited comparative studies across institutions. This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.
We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey. The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%, and defined as high robotic proportion cohort and low robotic proportion cohort. We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching (PSM). To account for potential clustering effects within hospitals, we employed Generalized Estimating Equations with hospital as the clustering variable.
This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer. In low robotic proportion cohort, RG had a longer operation time (P<0.001) but similar blood loss (P=0.792) compared to LG. In the high robotic proportion cohort, RG showed longer operation time (P<0.001), less blood loss (P<0.001), and shorter hospital stays (P<0.001) compared to LG. Additionally, RG in the high robotic proportion cohort had shorter operative time (P<0.001) and less blood loss (P=0.024) compared with that in the low robotic proportion cohort.
RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis. However, RG offers limited benefits over LG at institutions with lower frequencies of RG use.
在全国范围内，与腹腔镜胃癌切除术（LG）相比，机器人胃癌切除术（RG）的安全性仍不确定，跨机构的比较研究有限。本研究旨在利用全国性调查的数据比较RG和LG之间的发病率。
我们利用了韩国胃癌协会2019年全国性调查的数据。每个机构将微创手术中机器人手术的比例使用10%的临界值进行分类，并定义为高机器人比例队列和低机器人比例队列。我们使用倾向得分匹配（PSM）分析了每个队列中机器人手术和腹腔镜手术之间的手术结果。为了考虑医院内潜在的聚类效应，我们采用了以医院为聚类变量的广义估计方程。
本研究纳入了776例行RG的患者和7804例行LG的胃癌患者。在低机器人比例队列中，与LG相比，RG的手术时间更长（P<0.001），但失血量相似（P=0.792）。在高机器人比例队列中，与LG相比，RG的手术时间更长（P<0.001），失血量更少（P<0.001），住院时间更短（P<0.001）。此外，高机器人比例队列中的RG与低机器人比例队列中的RG相比，手术时间更短（P<0.001），失血量更少（P=0.024）。
在全国性的PSM分析中，RG显示出与LG相当的围手术期结果。然而，在RG使用频率较低的机构中，RG相对于LG的优势有限。
