title: Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study.
abstract: BACKGROUND
  Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study was designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer.
  
  
  METHODS
  Between June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were performed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical performance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared between the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated.
  
  
  RESULTS
  There were no significant differences in patient characteristics between the two groups. Mean tumor size was larger in the laparoscopic than in the robotic patients (5.3 ± 0.5 cm and 3.0 ± 0.4 cm, respectively; P = 0.02). However, tumor stage distribution was similar between the two groups. The mean number of dissected lymph nodes was higher in the robotic than in the laparoscopic patients (39.1 ± 3.7 and 30.5 ± 2.0, respectively; P = 0.02). The mean operative time was 262.6 ± 8.6 min in the laparoscopic group and 312.6 ± 15.7 min in the robotic group (P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic and in the robotic patients. There were no significant differences in short-term clinical outcomes between the two groups.
  
  
  CONCLUSIONS
  Within the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal gastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic surgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and examined lymph nodes.
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy. fabio.cianchi@unifi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cianchi
authors.affiliation: IFCA, Florence, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Indennitate
authors.affiliation: Unit of Gastroenterology, University Hospital Careggi, Florence, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Trallori
authors.affiliation: IFCA, Florence, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Ortolani
authors.affiliation: IFCA, Florence, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Paoli
authors.affiliation: Unit of Gastroenterology, University Hospital Careggi, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macrì
authors.affiliation: Unit of Gastroenterology, University Hospital Careggi, Florence, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lami
authors.affiliation: ISPO, Florence, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mallardi
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Badii
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Staderini
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Etleva
authors.initials: E
authors.lastname: Qirici
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Taddei
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Maria Novella
authors.initials: MN
authors.lastname: Ringressi
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Messerini
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Novelli
authors.affiliation: Unit of Gastroenterology, University Hospital Careggi, Florence, Italy.
authors.forename: Siro
authors.initials: S
authors.lastname: Bagnoli
authors.affiliation: Unit of Gastroenterology, University Hospital Careggi, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bonanomi
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Foppa
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Ileana
authors.initials: I
authors.lastname: Skalamera
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Fiorenza
authors.affiliation: Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Perigli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Distal gastrectomy; Gastric cancer; Laparoscopy; Lymphadenectomy; Robotic surgery