2358P - Assessing the efficacy of robot-assisted total gastrectomy for advanced proximal gastric cancer: Results from a three-year clinical trial

Background

Robotic total gastrectomy (RTG) is accepted as a safety approach to conventional laparoscopy total gastrectomy (LTG) for locally advanced gastric cancer. However, the long-term oncological efficacy of RTG remains unclear.

Methods

This prospective study included 48 patients with advanced proximal GC underwent RTG combined with spleen-preserving splenic hilar lymphadenectomy between March 2018 and February 2020. Patients who underwent LTG in the FUGES-002 study were enrolled in a 1:2 ratio to compare the outcomes between RTG and LTG. The primary outcome was overall postoperative morbidity rate. The secondary outcomes were three-year overall survival (OS), three-year disease-free survival (DFS), and recurrence patterns.

Results

After 1:2 propensity score matching, a total of 48 RTG and 96 LTG patients were included, with similar clinical and pathological data in both groups. In terms of surgical outcomes, the RTG group had significantly less intraoperative bleeding than the LTG group (66.4 vs. 38.7 ml, P = 0.042). With regard to lymph node dissection, the RTG group had a significantly higher number of non-gastric lymph node dissections than the LTG group (20.2 vs. 17.5, P = 0.039), and its lymph node metastasis rate was significantly lower than that of the LTG group (27.1% vs. 45.8%, P = 0.030); in terms of postoperative outcomes, the RTG group had significantly shorter times for first gas discharge, first out of bed, first liquid diet, first semi-liquid diet, and length of stay than the LTG group (P <0.05). Regarding long-term prognosis, the 3-year DFS of the RTG and LTG groups were 77.1% and 68.8%, respectively, and the 3-year OS were 85.4% and 74.0% (P >0.05 for both). Within 3 years after surgery, 9 (18.8%) and 27 (28.1%) patients in the RTG and LTG groups experienced recurrence, respectively, with similar recurrence patterns in both groups (P >0.05). There was no independent correlation between RTG and recurrence or gastric cancer-specific death (P >0.05 for both).

Conclusions

Among patients with a preoperative clinical stage indicating locally advanced gastric cancer, RTG, compared with LTG, did not result in inferior disease-free survival and overall survival at 3 years.

Clinical trial identification

The FUGES-014 was a prospective, single-arm, open-label study (NCT03524287) that was conducted at Fujian Medical University Union Hospital (FMUUH).

Editorial acknowledgement

Legal entity responsible for the study

Changming Huang.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.