OGC SO44 - Robotic gastric resection is feasible and safe - the first 25 cases at a tertiary UK Oesophago-gastric unit

Abstract Background Robotic approaches to upper GI surgery are being increasingly used due to purported benefits including improved vision and dexterity over conventional laparoscopy, and reduction in surgical trauma and wound-related morbidity over open surgery. Introduction of new technology and its implementation into practice comes with an inevitable learning curve and it is paramount that this does not occur at the expense of patient outcomes. This study looked at the surgical and oncological outcomes from the implementation of a robotic gastric resectional service at a tertiary centre in the UK. Method A prospectively maintained database was used to identify all patients undergoing robotic subtotal and total gastrectomy irrespective of indication. Patients having sleeve gastrectomy or gastric wedge resection were not included. Demographic, operative, pathological and complications data were included. Complications were graded using the Clavien-Dindo classification. Textbook outcomes for gastric cancer surgery were defined as complete resection, pathological R0, >15 lymph nodes resected, no intraoperative complications, no reintervention, no ICU readmission, no prolonged hospital stay (defined as > 21 days), no mortality or readmission at 30 days, and no severe complications (Clavien Dindo ≥ II). Results Twenty-five patients were identified, 13 (52%) were women and the median age was 73 (range: 40 – 88). Twenty-two (92%) had a subtotal gastrectomy and adenocarcinoma was the diagnosis in 15 (62.5%). Median blood loss was 50ml (50 – 310 ml) and operative time 320 minutes (225 – 480 minutes). There were no conversions to open. Complications occurred in 6 (24%) with one leak, 2 theatre returns, one death and no readmissions. Median stay was 6 days (4-14 days). Of the 16 having cancer surgery, median nodal yield was 29.5 (16 – 66), R0 rate 100% and a textbook outcome achieved in 14 (87.5%). Conclusion Robotically-assisted gastric resection can be implemented with a low rate of complication. In those patients having surgery for cancer, pathological outcomes were good and 14/16 patients achieved a textbook outcome which is significantly higher than most published studies.