Comparison of robotic gastrectomy with D2 lymphadenectomy with laparoscopic gastrectomy with D2 lymphadenectomy for patients with high body mass index

Abstract

Background: Minimally invasive surgery (MIS) has become one of the treatments of choice for gastric cancer. However, applying MIS to patients with high body mass index is technically challenging, especially when performing D2 lymphadenectomy. We hypothesized that robot surgery would affect the results of gastrectomy with D2 lymphadenectomy in high body mass index(BMI) patients. To assess the impact of surgical methods and BMI, we compared surgical outcomes of robotic distal gastrectomy (RDG) and laparoscopic distal gastrectomy (LDG) for patients with different BMIs.Methods: Between 2003 and 2010, 400 gastric cancer patients underwent radical distal gastrectomy with D2 lymphadenectomy. Patients were categorized by surgical approaches and their BMIs. We compared surgical outcomes between each group.Results: Regardless of BMI, RDG required significantly longer operation time than LDG (p=0.001). Among high BMI patients, the RDG group showed significantly less blood loss than the LDG group (66.8±61.3mL vs. 157.2±338.4mL, p=0.018). The radicality of each surgical approach for high BMI group was considered similar, evidenced by comparable numbers of retrieved lymph nodes. In high BMI patients, the frequency of complications did not differ significantly between surgical approaches. However, although statistically not significant, the RDG group showed decreased incidences of moderate to severe complications(3.2%) compared to the LDG group(9.0%).Conclusions: In gastric cancer, the effects of robotic application were more evident for high BMI patients than normal BMI patients, based on blood loss and complication severity. Gastric cancer patients with high BMI could therefore be good candidates for robotic surgery when surgeons select surgical methods for treatment.