Comparison of robot-assisted surgery, laparoscopic-assisted surgery, and conventional open surgery for the treatment of gastric cancer： A network meta-analysis

Objective: To systematically evaluate the predictive efficacy of robotic-assisted distal gastrectomy (RG) with D2 lymphadenectomy. Methods Through PubMed, Embase, Cochrane Library, Ovid, and other databases, the English literature comparing three surgical procedures of conventional open distal gastrectomy, laparoscopic-assisted distal gastrectomy, and robot-assisted distal gastrectomy published from 2015 to December 2021 were collected. The included literature's quality was evaluated using the Newcastle-Ottawa Scale (NOS) and Jadad scale, and Meta-analysis was performed using Review Manager 5.4 and R-Studio software. Results A total of 13,724 patients were included in 29 publications. Meta-analysis showed that among the three had surgical modalities, the robotic-assisted treatment took the longest time in terms of operative time and was most likely to cause postoperative intestinal obstruction, but performed best in terms of length of hospital stay and had the best postoperative results in preventing abdominal infection, bleeding, anastomotic leakage, pneumonia, and overall postoperative complications. Conclusion Robotic-assisted distal gastrectomy is safe and feasible. Patients have an excellent postoperative prognosis, but there are still some problems with the robotic-assisted treatment itself and more aspects to be considered clinically. We expect to improve robotic technology and promote the development of minimally invasive surgery in the future.