Yu Yang, Yamauchi Suguru, Zhang Peining, Fukunaga Tetsu
Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, No. 52 Fucheng Rd, Haidian District, Beijing, 100142, China.
J Robot Surg. 2025 Jun 23;19(1):318. doi: 10.1007/s11701-025-02415-0.
The optimal minimally invasive surgical approach for proximal gastric cancer (PGC) remains controversial. This systematic review and pairwise meta-analysis incorporated propensity score-matched (PSM) and retrospective studies with balanced baseline characteristics (BB) studies. The objective of this study was to evaluate perioperative outcomes of robotic gastrectomy (RG) compared with laparoscopic gastrectomy (LG) in patients with PGC. A comprehensive literature search was carried out in alignment with PRISMA standards to identify eligible studies. Short-term outcomes were categorized into four domains: surgical performance, resection quality, postoperative complications, and recovery outcomes. Mean differences (MDs) and odds ratios (ORs), along with their corresponding 95% confidence intervals (CIs), were calculated as effect size estimates. Assessment of study quality involved evaluating the risk of bias and assessing potential publication bias, while heterogeneity and its potential sources were examined through sensitivity and subgroup analyses. This study included five PSM studies and three BB studies, with a total of 1163 PGC patients. Although RG was associated with a longer operative time compared to LG, it demonstrated advantages including reduced intraoperative blood loss, a greater number of dissected lymph nodes, shorter hospital stay, and earlier onset of flatus and oral intake. No statistically significant differences were observed in proximal margin, distal margin, non-R0 resection rate, overall complications, major complications, anastomotic leakage, anastomotic stricture, or reflux esophagitis. RG may provide improved short-term outcomes over LG for PGC. However, further high-quality evidence is necessary to validate these findings and thoroughly assess long-term outcomes.PROSPERO Registration: CRD420251019756.
近端胃癌（PGC）的最佳微创手术方法仍存在争议。本系统评价和成对荟萃分析纳入了倾向评分匹配（PSM）研究以及具有平衡基线特征（BB）的回顾性研究。本研究的目的是评估机器人胃癌切除术（RG）与腹腔镜胃癌切除术（LG）治疗PGC患者的围手术期结局。按照PRISMA标准进行了全面的文献检索，以确定符合条件的研究。短期结局分为四个领域：手术操作、切除质量、术后并发症和恢复结局。计算平均差（MDs）和比值比（ORs）及其相应的95%置信区间（CIs）作为效应量估计值。研究质量评估包括评估偏倚风险和潜在发表偏倚，同时通过敏感性和亚组分析检查异质性及其潜在来源。本研究纳入了5项PSM研究和3项BB研究，共1163例PGC患者。虽然与LG相比，RG的手术时间更长，但它显示出一些优势，包括术中失血减少、清扫淋巴结数量更多、住院时间更短、胃肠排气和开始经口进食更早。在近端切缘、远端切缘、非R0切除率、总体并发症、主要并发症、吻合口漏、吻合口狭窄或反流性食管炎方面未观察到统计学显著差异。对于PGC，RG可能比LG提供更好的短期结局。然而，需要进一步的高质量证据来验证这些发现并全面评估长期结局。PROSPERO注册号：CRD420251019756。
