title: Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma.
abstract: OBJECTIVE
  To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy.
  
  
  BACKGROUND
  Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy.
  
  
  METHODS
  A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis.
  
  
  RESULTS
  A total of 434 patients were enrolled for treatment with either robotic (n = 223) or laparoscopic (n = 211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n = 185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In per-protocol analysis, both groups showed similar overall complication rates (robotic = 11.9% vs laparoscopic = 10.3%) and major complication rates (robotic = 1.1% vs laparoscopic = 1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic = 221 minutes vs laparoscopic = 178 minutes; P < 0.001) and significantly higher total costs (robotic = US$13,432 vs laparoscopic = US$8090; P < 0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay.
  
  
  CONCLUSIONS
  The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.
authors.affiliation: *Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea †Gastric Cancer Center, Yonsei Cancer Center, Seoul, Republic of Korea ‡Robot & MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea §Department of Surgery, Ajou University College of Medicine, Seoul, Republic of Korea ¶Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea ||Center for Gastric Cancer, National Cancer Center, Seoul, Republic of Korea **Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea ††Department of Surgery, Dong-A University College of Medicine, Seoul, Republic of Korea ‡‡Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea §§Department of Surgery, The Catholic University of Korea, Seoul, Republic of Korea ¶¶Department of Surgery, Inje University College of Medicine, Seoul, Republic of Korea ||||Department of Surgery, Hallym University College of Medicine, Seoul, Republic of Korea ***Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea †††Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyoung-Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Sang-Uk
authors.initials: SU
authors.lastname: Han
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.forename: Joong-Min
authors.initials: JM
authors.lastname: Park
authors.forename: Ji Yeong
authors.initials: JY
authors.lastname: An
authors.forename: Min-Chan
authors.initials: MC
authors.lastname: Kim
authors.forename: Sungsoo
authors.initials: S
authors.lastname: Park
authors.forename: Kyo Young
authors.initials: KY
authors.lastname: Song
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Oh
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Kong
authors.forename: Byoung Jo
authors.initials: BJ
authors.lastname: Suh
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Yang
authors.forename: Tae Kyung
authors.initials: TK
authors.lastname: Ha
authors.forename: Youn Nam
authors.initials: YN
authors.lastname: Kim
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D005743:Gastrectomy / Q000191:economics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics; D013274:Stomach Neoplasms / Q000601:surgery*