柴崎 晋

OBJECTIVE: To evaluate contemporary short-term outcomes of robotic gastrectomy (RG) approximately 5 years after its widespread implementation, compared with laparoscopic gastrectomy (LG) using a nationwide Japanese database. BACKGROUND: RG has been introduced to overcome the technical limitations of LG; however, its real-world clinical advantages remain to be fully defined. METHODS: This retrospective study used the Japanese National Clinical Database to identify patients with gastric cancer who underwent minimally invasive distal gastrectomy (DG) or total gastrectomy (TG) between January 2023 and December 2024. Patients were classified as undergoing robotic (RDG or RTG) or laparoscopic (LDG or LTG) procedures. Propensity score matching was performed separately for the DG and TG cohorts to adjust for patient-, tumor-, and hospital-related confounders. The primary outcome was postoperative morbidity within 30 days (Clavien-Dindo grade ≥ IIIa). RESULTS: After propensity score matching, 9743 RDG-LDG pairs and 1617 RTG-LTG pairs were analyzed. RDG was associated with a significantly lower morbidity rate than LDG (4.3 vs. 4.9%, P = 0.049). Despite longer operative time, RDG was associated with lower blood loss, lower conversion rates, fewer intra-abdominal infectious complications, and shorter postoperative hospital stay than LDG. Overall morbidity did not differ significantly between RTG and LTG (8.7 vs. 8.3%, P = 0.66); however, RTG was associated with lower blood loss, lower conversion rates, and shorter hospital stay. CONCLUSIONS: RDG was associated with improvements in multiple short-term outcomes, whereas RTG still did not improve the primary outcome measure.

BACKGROUND: Although robot-assisted minimally invasive esophagectomy (RAMIE) reportedly provides better short-term and comparable long-term outcomes compared with open esophagectomy, its long-term outcomes versus those of minimally invasive esophagectomy (MIE) remain insufficiently investigated. This multicenter retrospective cohort study aimed to investigate the perioperative safety, efficacy, and long-term survival of patients of RAMIE versus MIE for esophageal cancer. METHODS: We included patients with cStage 0-IVa thoracic esophageal cancer who underwent esophagectomy through the right thoracic cavity between January 2016 and December 2019 in six Japanese hospitals. The short- and long-term outcomes between RAMIE and MIE were compared by using propensity score matching. RESULTS: After matching, 268 of 396 patients were analyzed. Compared with MIE, RAMIE had a longer operative time (629 vs. 574 min, p < 0.01), a trend toward less severe morbidity (Clavien-Dindo grade ≥ III: 18% vs. 23%), and a lower incidence (22% vs. 34%, p = 0.02) and mitigated severity of recurrent laryngeal nerve (RLN) palsy (p = 0.040). Blood loss, inhospital mortality, and the mediastinal node harvest were similar between the two techniques. The 3- and 5-year overall survival rates were 77% and 66% for RAMIE and 74% and 66% for MIE (hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.57-1.37; p = 0.59). Relapse-free survival was also similar (3-year 64% vs. 63%; 5-year 61% vs. 59%; HR 0.87; 95% CI 0.60-1.28; p = 0.49). CONCLUSIONS: RAMIE reduced the incidence and severity of RLN palsy despite requiring a longer operation time and demonstrated similar long-term outcomes to MIE.