title: Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer.
abstract: BACKGROUND
  In contrast to the significant advantages of laparoscopic versus open gastrectomy, robotic gastrectomy has shown little benefit over laparoscopic gastrectomy. This study aimed to compare multi-dimensional aspects of surgical outcomes after open, laparoscopic, and robotic gastrectomy.
  
  
  METHODS
  Data from 915 gastric cancer patients who underwent gastrectomy by one surgeon between March 2009 and May 2015 were retrospectively reviewed. Perioperative parameters were analyzed for short-term outcomes. Surgical success was defined as the absence of conversion to open surgery, major complications, readmission, positive resection margin, or fewer than 16 retrieved lymph nodes.
  
  
  RESULTS
  This study investigated 241 patients undergoing open gastrectomy, 511 patients undergoing laparoscopic gastrectomy, and 173 patients undergoing robotic gastrectomy. For each approach, the respective incidences were as follows: conversion to open surgery (not applicable, 0.4%, and 0%; p = 0.444), in-hospital major complications (5.8, 2.7, and 1.2%; p = 0.020), delayed complications requiring readmission (2.9, 2.0, and 1.2%; p = 0.453), positive resection margin (1.7, 0, and 0%; p = 0.003), and inadequate number of retrieved lymph nodes (0.4, 4.1, and 1.7%; p = 0.010). Compared with open and laparoscopic surgery, robotic gastrectomy had the highest surgical success rate (90, 90.8, and 96.0%). Learning-curve analysis of success using cumulative sum plots showed success with the robotic approach from the start. Multivariate analyses identified age, sex, and gastrectomy extent as significant independent parameters affecting surgical success. Surgical approach was not a contributing factor.
  
  
  CONCLUSIONS
  Open, laparoscopic, and robotic gastrectomy exhibited different incidences and causes of surgical failure. Robotic gastrectomy produced the best surgical outcomes, although the approach method itself was not an independent factor for success.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Seung Yoon
authors.initials: SY
authors.lastname: Yang
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Kun Ho
authors.initials: KH
authors.lastname: Roh
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: You-Na
authors.initials: YN
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Minah
authors.initials: M
authors.lastname: Cho
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Taeil
authors.initials: T
authors.lastname: Son
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. cairus@yuhs.ac.|Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea. cairus@yuhs.ac.|Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea. cairus@yuhs.ac.
authors.forename: Hyoung-Il
authors.initials: HI
authors.lastname: Kim
mesh_terms: D061887:Conversion to Open Surgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome