Robotic versus laparoscopic distal gastrectomy for resectable gastric cancer: a randomized phase 2 trial

Jun Lu, Bin-bin Xu, Hua-Long Zheng, Ping Li, Jian-wei Xie, Jia-bin Wang, Jian-xian Lin, Qi-yue Chen, Long-long Cao, Mi Lin, Ru-hong Tu, Ze-ning Huang, Ju-li Lin, Zi-hao Yao, Chao-Hui Zheng () and Chang-Ming Huang ()
Additional contact information
Jun Lu: Fujian Medical University Union Hospital
Bin-bin Xu: Fujian Medical University Union Hospital
Hua-Long Zheng: Fujian Medical University Union Hospital
Ping Li: Fujian Medical University Union Hospital
Jian-wei Xie: Fujian Medical University Union Hospital
Jia-bin Wang: Fujian Medical University Union Hospital
Jian-xian Lin: Fujian Medical University Union Hospital
Qi-yue Chen: Fujian Medical University Union Hospital
Long-long Cao: Fujian Medical University Union Hospital
Mi Lin: Fujian Medical University Union Hospital
Ru-hong Tu: Fujian Medical University Union Hospital
Ze-ning Huang: Fujian Medical University Union Hospital
Ju-li Lin: Fujian Medical University Union Hospital
Zi-hao Yao: Fujian Medical University Union Hospital
Chao-Hui Zheng: Fujian Medical University Union Hospital
Chang-Ming Huang: Fujian Medical University Union Hospital

Nature Communications, 2024, vol. 15, issue 1, 1-10

Abstract: Abstract Robotic surgery may be an alternative to laparoscopic surgery for gastric cancer (GC). However, randomized controlled trials (RCTs) reporting the differences in survival between these two approaches are currently lacking. From September 2017 to January 2020, 300 patients with cT1-4a and N0/+ were enrolled and randomized to either the robotic (RDG) or laparoscopic distal gastrectomy (LDG) group (NCT03313700). The primary endpoint was 3-year disease-free survival (DFS); secondary endpoints reported here are the 3-year overall survival (OS) and recurrence patterns. The remaining secondary outcomes include intraoperative outcomes, postoperative recovery, quality of lymphadenectomy, and cost differences, which have previously been reported. There were 283 patients in the modified intention-to-treat analysis (RDG group: n = 141; LDG group: n = 142). The trial has met pre-specified endpoints. The 3-year DFS rates were 85.8% and 73.2% in the RDG and LDG groups, respectively (p = 0.011). Multivariable Cox regression model including age, tumor size, sex, ECOG PS, lymphovascular invasion, histology, pT stage, and pN stage showed that RDG was associated with better 3-year DFS (HR: 0.541; 95% CI: 0.314-0.932). The RDG also improved the 3-year cumulative recurrence rate (RDG vs. LDG: 12.1% vs. 21.1%; HR: 0.546, 95% CI: 0.302-0.990). Compared to LDG, RDG demonstrated non-inferiority in 3-year DFS rate.

Date: 2024
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DOI: 10.1038/s41467-024-49013-6

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