J. T. Balbona1,2, M. Malafa1, S. Dineen1, R. Mehta1, J. M. Pimiento1 1Moffitt Cancer Center And Research Institute,Gastrointestinal Oncology,Tampa, FL, USA 2University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction:
Robotic-assisted gastrectomy is increasingly utilized for the treatment of gastric malignancies. While minimally-invasive laparoscopic surgery has shown many advantages over open gastrectomy, the benefits of robotic surgery have been less defined. This study aims to describe short and long-term outcomes associated with the establishment of comprehensive robotic program for gastric malignancies.
Methods:
Data from 46 patients who underwent robotic-assisted gastric resections at Moffitt Cancer Center between April 2013 and May 2018 were retrospectively examined. Pre-operative measures as well as short and long-term outcomes were analyzed using descriptive statistics. A subgroup analysis of outcomes was conducted to evaluate the different surgical procedures performed in patients with gastric adenocarcinoma (GC).
Results:
This cohort consisted of 46 patients (pts.), 26 (56.5%) males, a median of 64 years (range: 29-87). Pathology included GC (70%), GIST (11%), neuroendocrine tumors (7%), metastatic lesions (2%), and benign processes (7%). 19 pts. underwent total gastrectomy, 16 distal gastrectomy, 4 subtotal gastrectomy and 7 wedge resection. As expected, distal gastrectomy (237.5 ± 71, p < 0.001) and wedge resection (126 ± 90, p < 0.001) had significantly shorter operative times than total gastrectomy (394 ± 110). Moreover, operative time in total gastrectomy decreased approximately 1h from the first half of GC cases to the latter half (426 ± 115 vs. 340 ± 92; p = 0.06). Overall, there was a median estimated intraoperative blood loss of 100 mL (range: 20-400). Post-operative length of stay (LOS) was shorter after distal (5 ± 1.5, p < 0.001), subtotal (6 ± 1.7, p < 0.001), and wedge gastrectomy (3 ± 2.2, p < 0.001) than after total gastrectomy (10 ± 4.7). 8.8% (4) of operations were converted to open and 28.2% (13) of pts. had post-operative complications, 8.7% (4) requiring readmission. The incidence of post-operative anastomotic leak, pneumonia, and ileus were 6.5% (3), 8.7% (4), and 10.9% (5), respectively. For pts. with GC, 69% received neoadjuvant therapy. The median lymph nodes removed were 20 (range: 14-46), 25.5 (range: 25-26) and 17 (range: 9-34) during total, subtotal and distal gastrectomy, respectively. All pts. underwent margin negative resection. The median follow-up for GC was 18m, and 60% of pts. received adjuvant therapy at a median of 59d (range: 23-106). GC recurred in 21% of pts.
Conclusion:
Our experience highlights the versatility of the robotic platform to tackle multiple pathologic diagnoses requiring oncologic total gastrectomies, from GIST, to metastatic disease, to adenocarcinoma. Our results compare adequately with previous series from our institution and are a good starting point to establish benchmarks to improve short and long-term outcomes, especially in relation to LOS and time to initiation of therapy.