Surgical invasiveness and lymphadenectomy in robotic and laparoscopic gastrectomy: A retrospective study with propensity-score matching


      • Robotic gastrectomy (RG) retrieves more lymph nodes than laparoscopy in gastric cancer.
      • Specific areas of lymph nodes involved supra-pancreatic and lesser curvature areas.
      • RG is associated with decreased blood loss and lower CRP level than laparoscopic gastrectomy (LG).
      • No difference in complications, length of stay, or mortality between RG and LG.
      • RG could provide better surgical and oncological procedures than LG.



      There is no consensus amongst comparative studies about the advantages of robotic over laparoscopic surgeries for gastric cancer (GC). We compared invasiveness and lymph node dissection between robotic and laparoscopic gastrectomies (RG and LG).


      We retrospectively reviewed the medical records of 215 consecutive patients with GC who underwent RG or LG with lymphadenectomy from January 2011–December 2020. Propensity score matching analysis was performed to control selection bias.


      The RG group had less operative blood loss (P = 0.0005) and higher C-reactive protein levels on postoperative day 1 (P = 0.0006) than the LG group. When analyzing the specific sites of dissected lymph nodes, station groups of supra-pancreatic and lesser curvature areas accounted for this difference (P = 0.0073 and 0.0362, respectively).


      RG demonstrated lesser intraoperative bleeding, less of a postoperative inflammatory response, and a higher proportion of lymph node removal than LG, suggesting that it is a better surgical and oncological procedure.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bray F.
        • Ferlay J.
        • Soerjomataram I.
        • et al.
        Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2018; 68: 394-424
        • Uyama I.
        • Suda K.
        • Nakauchi M.
        • et al.
        Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study.
        Gastric Cancer. 2019; 22: 377-385
        • Parisi A.
        • Reim D.
        • Borghi F.
        • et al.
        Minimally invasive surgery for gastric cancer: a comparison between robotic, laparoscopic and open surgery.
        World J Gastroenterol. 2017; 23: 2376-2384
        • Yang S.Y.
        • Roh K.H.
        • Kim Y.N.
        • et al.
        Surgical outcomes after open, laparoscopic, and robotic gastrectomy for gastric cancer.
        Ann Surg Oncol. 2017; 24: 1770-1777
        • Woo Y.
        • Hyung W.J.
        • Pak K.H.
        • et al.
        Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers.
        Arch Surg. 2011; 146: 1086-1092
        • Ye S.P.
        • Shi J.
        • Liu D.N.
        • et al.
        Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center.
        Sci Rep. 2020; 10: 6502
        • Suda K.
        • Man -I.M.
        • Ishida Y.
        • et al.
        Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study.
        Surg Endosc. 2015; 29: 673-685
      1. Japanese classification of gastric carcinoma: 3rd. English.
        Gastric Cancer. 2011; 14: 101-112
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Bassi C.
        • Marchegiani G.
        • Dervenis C.
        • et al.
        The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after.
        Surgery. 2017; 161: 584-591
        • Japanese Gastric Cancer Association
        Japanese gastric cancer treatment guidelines 2014 (ver. 4).
        Gastric Cancer. 2017; 20: 1-19
        • Mori T.
        • Kimura T.
        • Kitajima M.
        Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan.
        Minim Invasive Ther Allied Technol. 2010; 19: 18-23
        • Kaida S.
        • Murakami Y.
        • Ohta S.
        • et al.
        A novel technique to predict liver damage after laparoscopic gastrectomy from the stomach volume overlapping the liver by preoperative computed tomography.
        World J Surg. 2020; 44: 3052-3060
        • Hashizume M.
        • Sugimachi K.
        Robot-assisted gastric surgery.
        Surg Clin North Am. 2003; 83: 1429-1444
        • Kim H.I.
        • Han S.U.
        • Yang H.K.
        • et al.
        Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma.
        Ann Surg. 2016; 263: 103-109
        • Pan H.F.
        • Wang G.
        • Liu J.
        • et al.
        Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer.
        Surg Laparosc Endosc Percutaneous Tech. 2017; 27: 428-433
        • Wang W.J.
        • Li H.T.
        • Yu J.P.
        • et al.
        Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study.
        Surg Endosc. 2019; 33: 3341-3354
        • Gao Y.
        • Xi H.
        • Qiao Z.
        • et al.
        Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short- and long-term results.
        Surg Endosc. 2019; 33: 528-534
        • Kim K.M.
        • An J.Y.
        • Kim H.I.
        • Cheong J.H.
        • Hyung W.J.
        • Noh S.H.
        Major early complications following open, laparoscopic and robotic gastrectomy.
        Br J Surg. 2012; 99: 1681-1687
        • Okabe H.
        • Obama K.
        • Tsunoda S.
        • et al.
        Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer.
        Surg Today. 2019; 49: 820-827
        • Tokunaga M.
        • Makuuchi R.
        • Miki Y.
        • et al.
        Late phase II study of robot-assisted gastrectomy with nodal dissection for clinical stage I gastric cancer.
        Surg Endosc. 2016; 30: 3362-3367
        • Noshiro H.
        • Ikeda O.
        • Urata M.
        Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone.
        Surg Endosc. 2014; 28: 1180-1187
        • Lee J.H.
        • Kang J.W.
        • Nam B.H.
        • et al.
        Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: a multi-institutional cohort study.
        Eur J Surg Oncol. 2017; 43: 432-439
        • Kawamura Y.
        • Satoh S.
        • Suda K.
        • et al.
        Critical factors that influence the early outcome of laparoscopic total gastrectomy.
        Gastric Cancer. 2015; 18: 662-668
        • Yoshikawa T.
        • Cho H.
        • Rino Y.
        • et al.
        A prospective feasibility and safety study of laparoscopy-assisted distal gastrectomy for clinical stage I gastric cancer initiated by surgeons with much experience of open gastrectomy and laparoscopic surgery.
        Gastric Cancer. 2013; 16: 126-132
        • Wada N.
        • Kurokawa Y.
        • Takiguchi S.
        • et al.
        Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer.
        Gastric Cancer. 2014; 17: 137-140
        • Yang K.
        • Cho M.
        • Roh C.K.
        • et al.
        Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer.
        Surg Endosc. 2019; 33: 2357-2363
        • Ojima T.
        • Nakamura M.
        • Nakamori M.
        • et al.
        Robotic radical lymphadenectomy without touching the pancreas during gastrectomy for gastric cancer.
        Med (Baltim). 2019; 98e15091