Comparison of operative outcomes among laparoscopic, 3d-laparoscopic, and robotic gastrectomy for distal gastric cancer

Objective: Minimally invasive surgery has become popular in the treatment of gastric cancer. Background: Few reports have compared operative outcomes among laparoscopic, 3- dimensional (3D)-laparoscopic, and robotic gastrectomy for distal gastric cancer. Methods: Between August 2011 and June 2020, a total of 245 patients underwent laparoscopic (n 129), 3D-laparoscopic (n 55), or robotic (n 61) gastrectomy for distal gastric cancer; the clinicopathologic characteristics and operative outcomes were compared among groups. Results: Compared with the laparoscopic group, the 3D-laparoscopic and robotic groups were associated with more D2 lymphadenectomy, higher medical costs, and a longer operative time, whereas the number of retrieved lymph nodes and surgical complications were similar among the 3 groups. For patients receiving D2 lymphadenectomy, the robotic group was associated with higher medical costs and longer operative time than the other 2 groups; patients with high body mass index (high BMI) had a longer operative time than patients with low BMI in the laparoscopic group, which was not significantly different between patients with low or high BMI in both the 3D-laparoscopic and robotic groups. For patients with low BMI, the medical costs were higher and the operative time was longer in the robotic group than the other 2 groups. For patients with high BMI, the robotic group was associated with higher medical costs, and longer operative time and postoperative hospital stay than the other 2 groups. Conclusions: 3D-laparoscopic gastrectomy was associated with affordable medical costs, comparable lymphadenectomy, and similar surgical outcomes compared with robotic gastrectomy.