Robotic surgery for gastric cancer in the west: A systematic review and meta-analyses of short-and long-term outcomes

Background: This review aims to merge all the western studies dealing with robotic gastrectomies (RG) to provide pooled results and higher levels of evidence supporting the use of robotic gastrectomy for the treatment of gastric cancer also at western latitudes. Methods: A systematic literature search was performed in PubMed, Embase, and Scopus for studies published between 2010 and 2020 concerning RG in western centers. Case series and comparative studies (robotic versus open and robotic versus laparoscopic) were included. Results: After screening 1732 articles, 10 articles with a total of 988 patients undergoing RG in western centers were eligible for inclusion. Included studies showed a relatively low risk of bias. The pooled conversion rate was 3.9% (95% CI 1.2–7.9). The pooled overall complications rate was 15% (7.1–25.3) with a mortality rate of 2.5% (1.1–4.7). The pooled 5-year overall survival rate was 60.4% (46.0–74.1). The pooled analyses of the comparative studies (robotic versus open) included 132 robotic and 305 open gastrectomies and showed comparable safety parameters. The robotic group had a pooled 5-year overall survival of 55.2% (33.7–75.8) versus 50.8% (36.4–65.2) of the open group (RR 1.10, 0.78–1.55; p = 0.248 – I2 51.8, 0.0–86.1; p = 0.125). The meta analyses of the results from the studies comparing the robotic (n = 679) and the laparoscopic (n = 1355) approach (LG) showed similar morbidity (RG 19.9%, 10.2–32.0 versus LG 15.6%, 8.7–24.0; p = 0.706) and mortality rates (RG 5.5%, 3.9–7.3 versus LG 4.3%, 3.3–5.4; p = 0.272). RG had longer operative time (RG 327 min, 297–358 versus LG 248, 222–275; p = 0.001) and lower blood loss (RG 99 ml, 96–103 versus LG 133, 104–161; p < 0.001) than laparoscopic gastrectomy. Conclusion: Based on the available data from western centers, robotic gastrectomy is comparable with the open and the laparoscopic approaches with regards to short term outcomes. Survival data of RG were similar to open gastrectomies, but studies on long-term outcomes are required to confirm these results.