title: Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis.
abstract: OBJECTIVE
  To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed.
  
  
  METHODS
  A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included.
  
  
  RESULTS
  Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; Department of General and Oncologic Surgery, SS Antonio and Biagio Hospital, Alessandria, University of Turin, Turin, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marano
authors.forename: Yoon Young
authors.initials: YY
authors.lastname: Choi
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Yoo Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
keywords: Gastrectomy; Laparoscopy; Robotics; Stomach neoplasms