Robotic versus laparoscopic surgery for gastric cancer: an overview of systematic reviews with quality assessment of cur
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REVIEW ARTICLE
Robotic versus laparoscopic surgery for gastric cancer: an overview of systematic reviews with quality assessment of current evidence Nobuaki Hoshino1 · Katsuhiro Murakami1 · Koya Hida1 · Shigeo Hisamori1 · Shigeru Tsunoda1 · Kazutaka Obama1 · Yoshiharu Sakai1 Received: 11 November 2019 / Accepted: 5 May 2020 © Italian Society of Surgery (SIC) 2020
Abstract Many systematic reviews have been published to evaluate the clinical benefits of robotic surgery for gastric cancer. However, these reviews have investigated various outcomes and differ considerably in quality. In this overview, we summarize the findings and quality of these reviews. A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials to identify systematic reviews and meta-analyses that compared robotic surgery with laparoscopic surgery for gastric cancer. We summarized the results of the meta-analyses and evaluated the quality of the reviews using the AMSTAR-2 tool. The literature search identified 14 eligible reviews. The reviews showed that estimated blood loss was significantly less and time to resumption of oral intake was significantly shorter in patients who underwent robotic surgery than in those who underwent laparoscopic surgery. However, no significant differences in other outcomes were found between the two types of surgery. The quality of the included reviews was judged to be critically low. In conclusion, the available evidence, albeit of critically low quality, suggests that robotic surgery decreases estimated blood loss and shortens the time to resumption of oral intake in patients with gastric cancer. There is currently no high-quality evidence that robotic surgery has clinical benefits for gastric cancer patients. Keywords Stomach · Oncology · Laparoscopy · Robot · Overview
Introduction Surgery for gastric cancer has traditionally been performed via an open approach. However, this approach is invasive and recovery is protracted. Laparoscopic surgery was first performed in 1991 [1] and is becoming increasingly widespread because it is less invasive than open surgery. Laparoscopic surgery has been reported to achieve better short-term outcomes in patients with gastric cancer, including earlier recovery and a shorter hospital stay [2–4]. Furthermore, a recent meta-analysis reported that there was no significant difference in likelihood of recurrence of cancer between Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00793-8) contains supplementary material, which is available to authorized users. * Nobuaki Hoshino [email protected]‑u.ac.jp 1
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin‑Kawahara‑cho, Sakyo‑ku, Kyoto 606‑8507, Japan
laparoscopic gastrectomy and open gastrectomy [5]. However, although the surgical invasiveness for patients could be minimized by laparoscopic surgery, there remain technical problems, including two-dimensional views, involuntar
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