World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 14, Number 5, October 2023, pages 371-381

Trends of Oncological Quality of Robotic Gastrectomy for Gastric Cancer in the United States

**Table 1.** Demographic and Facility Characteristics of Patients With Gastric Cancer Who Underwent Gastrectomy
	All patients (N = 22,445)	Open (N = 14,598)	Laparoscopic (N = 5,980)	Robotic (N = 1,867)	P value
IQR: interquartile range; CCP: community cancer program; CCCP: comprehensive community cancer program; AP: academic and research program; INCP: integrated network cancer program; CXRT: chemoradiotherapy.
Age, years (median, IQR)	66	58 - 74	67	58 - 75	66	58 - 74	65	57 - 73	< 0.001
Sex									< 0.001
Male	15,379	68.5	9,838	67.4	4,200	70.2	1,341	71.8
Female	7,066	31.5	4,760	32.6	1,780	29.8	526	28.2
Race and ethnicity									< 0.001
Non-Hispanic white	15,106	67.3	9,651	66.1	4,195	70.2	1,260	67.5
Non-Hispanic black	2,654	11.8	1,937	13.3	551	9.2	166	8.9
Hispanic or Latino	2,256	10.1	1,530	10.5	535	9.0	191	10.2
Asian	2,013	9.0	1,211	8.3	589	9.9	213	11.4
Other/unknown	416	1.9	269	1.8	110	1.8	37	2.0
Facility type									< 0.001
CCP	676	3.01	538	3.7	111	1.9	27	1.5
CCCP	6,259	27. 9	4,486	30.7	1,380	23.1	393	21.1
AP	11,443	51.0	6,863	47.0	3,446	57.6	1,134	60.7
INCP	4,067	18.1	2,711	18.6	1,043	17.4	313	16.8
Insurance type									< 0.001
Private insurance	8,046	35.8	5,116	35.1	2,193	36.7	737	39.5
Not insured	542	2.4	407	2.8	99	1.7	36	1.9
Government plans	13,601	60.6	8,885	60.9	3,640	60.9	1,076	57.6
Unknown	256	1.1	190	1.3	48	0.8	18	1.0
Clinical T category									< 0.001
T0	225	1	144	0.99	63	1.1	18	1.0
T1	3,383	15.1	2,127	14.6	987	16.5	269	14.4
T2	2,888	12.9	1,764	12.1	854	14.3	270	14.5
T3	6,714	29.9	4,286	29.4	1,883	31.5	545	29.1
T4	883	3.9	648	4.4	181	3.0	54	2.9
TX	8,352	37.2	5,629	38.6	2,012	33.7	711	38.1
Clinical N category									< 0.001
N0	11,281	50.2	7,370	50.5	3,064	51.2	847	45.4
N+	6,368	28.4	4,145	28.4	1,712	28.7	511	27.4
NX	4,796	21.4	3,083	21.1	1,204	20.1	509	27.2
Surgical procedure									< 0.001
Total gastrectomy	7,441	33.2	4,949	33.9	1,904	31.8	588	31.5
Subtotal/distal gastrectomy	7,724	34.4	5,233	35.9	1,882	31.5	609	32.6
Proximal gastrectomy	7,280	32.4	4,416	30.2	2,194	36.7	670	35.9
Preoperative treatment									< 0.001
Upfront surgery	8,102	36.1	5,362	36.7	2,165	36.2	575	30.8
Chemo	3,982	17.7	2,543	17.4	1,028	17.2	411	22.0
CXRT	5,606	25.0	3,291	22.5	1,699	28.4	616	33.0
Unknown	4,755	21.2	3,402	23.3	1,088	18.2	265	14.2
Charlson-Deyo score									0.124
0	14,478	64.5	9,369	64.2	3,861	64.6	1,248	66.9
1	5,401	24.1	3,551	24.3	1,417	23.7	433	23.2
≥ 2	2,566	11.4	1,678	11.5	702	11.7	186	10.0
Pathologic T category									< 0.001
T0	1,250	5.6	740	5.1	351	5.9	159	8.5
T1	5,238	23.3	3,154	21.5	1,631	27.3	453	24.2
T2	2,912	13.0	1,894	13.0	801	13.3	217	11.6
T3	7,027	31.3	4,787	32.8	1,794	30.0	446	23.9
T4	2,939	13.1	2,256	15.5	553	9.3	130	7.0
Unknown	3,079	13.7	1,767	12.1	850	14.2	462	24.8
Pathologic N category									< 0.001
N0	10,007	44.6	6,264	42.9	2,894	48.4	849	45.5
N1	3,560	15.9	2,368	16.3	941	15.7	251	13.4
N2	2,899	12.9	2,049	14.0	677	11.3	173	9.2
N3	2,793	12.4	2,078	14.2	585	9.8	130	7.0
Unknown	3,186	14.2	1,839	12.6	883	14.8	464	24.9

Table 1. Demographic and Facility Characteristics of Patients With Gastric Cancer Who Underwent Gastrectomy

All patients (N = 22,445)

Open (N = 14,598)

Laparoscopic (N = 5,980)

Robotic (N = 1,867)

P value

IQR: interquartile range; CCP: community cancer program; CCCP: comprehensive community cancer program; AP: academic and research program; INCP: integrated network cancer program; CXRT: chemoradiotherapy.

Age, years (median, IQR)

58 - 74

58 - 75

58 - 74

57 - 73

< 0.001

Sex

< 0.001

Male

15,379

68.5

9,838

67.4

4,200

70.2

1,341

71.8

Female

7,066

31.5

4,760

32.6

1,780

29.8

526

28.2

Race and ethnicity

< 0.001

Non-Hispanic white

15,106

67.3

9,651

66.1

4,195

70.2

1,260

67.5

Non-Hispanic black

2,654

11.8

1,937

13.3

551

9.2

166

8.9

Hispanic or Latino

2,256

10.1

1,530

10.5

535

9.0

191

10.2

Asian

2,013

9.0

1,211

8.3

589

9.9

213

11.4

Other/unknown

416

1.9

269

1.8

110

1.8

2.0

Facility type

< 0.001

CCP

676

3.01

538

3.7

111

1.9

1.5

CCCP

6,259

27. 9

4,486

30.7

1,380

23.1

393

21.1

11,443

51.0

6,863

47.0

3,446

57.6

1,134

60.7

INCP

4,067

18.1

2,711

18.6

1,043

17.4

313

16.8

Insurance type

< 0.001

Private insurance

8,046

35.8

5,116

35.1

2,193

36.7

737

39.5

Not insured

542

2.4

407

2.8

1.7

1.9

Government plans

13,601

60.6

8,885

60.9

3,640

60.9

1,076

57.6

Unknown

256

1.1

190

1.3

0.8

1.0

Clinical T category

< 0.001

225

144

0.99

1.1

1.0

3,383

15.1

2,127

14.6

987

16.5

269

14.4

2,888

12.9

1,764

12.1

854

14.3

270

14.5

6,714

29.9

4,286

29.4

1,883

31.5

545

29.1

883

3.9

648

4.4

181

3.0

2.9

8,352

37.2

5,629

38.6

2,012

33.7

711

38.1

Clinical N category

< 0.001

11,281

50.2

7,370

50.5

3,064

51.2

847

45.4

N+

6,368

28.4

4,145

28.4

1,712

28.7

511

27.4

4,796

21.4

3,083

21.1

1,204

20.1

509

27.2

Surgical procedure

< 0.001

Total gastrectomy

7,441

33.2

4,949

33.9

1,904

31.8

588

31.5

Subtotal/distal gastrectomy

7,724

34.4

5,233

35.9

1,882

31.5

609

32.6

Proximal gastrectomy

7,280

32.4

4,416

30.2

2,194

36.7

670

35.9

Preoperative treatment

< 0.001

Upfront surgery

8,102

36.1

5,362

36.7

2,165

36.2

575

30.8

Chemo

3,982

17.7

2,543

17.4

1,028

17.2

411

22.0

CXRT

5,606

25.0

3,291

22.5

1,699

28.4

616

33.0

Unknown

4,755

21.2

3,402

23.3

1,088

18.2

265

14.2

Charlson-Deyo score

0.124

14,478

64.5

9,369

64.2

3,861

64.6

1,248

66.9

5,401

24.1

3,551

24.3

1,417

23.7

433

23.2

≥ 2

2,566

11.4

1,678

11.5

702

11.7

186

10.0

Pathologic T category

< 0.001

1,250

5.6

740

5.1

351

5.9

159

8.5

5,238

23.3

3,154

21.5

1,631

27.3

453

24.2

2,912

13.0

1,894

13.0

801

13.3

217

11.6

7,027

31.3

4,787

32.8

1,794

30.0

446

23.9

2,939

13.1

2,256

15.5

553

9.3

130

7.0

Unknown

3,079

13.7

1,767

12.1

850

14.2

462

24.8

Pathologic N category

< 0.001

10,007

44.6

6,264

42.9

2,894

48.4

849

45.5

3,560

15.9

2,368

16.3

941

15.7

251

13.4

2,899

12.9

2,049

14.0

677

11.3

173

9.2

2,793

12.4

2,078

14.2

585

9.8

130

7.0

Unknown

3,186

14.2

1,839

12.6

883

14.8

464

24.9

**Table 2.** Short-Term Outcomes by Gastrectomy Approach
	All patients (N = 22,445)	Open (N = 14,598)	Laparoscopic (N = 5,980)	Robotic (N = 1,867)	P value
IQR: interquartile range.
Number of lymph nodes examined	16	10 - 24	16	10 - 23	17	11 - 25	19	12 - 27	< 0.001
R0	20,159	89.8	12,911	88.4	5,499	92.0	1,749	93.7	< 0.001
Length of hospital stay, days	8	6 - 12	9	7 - 13	8	6 - 11	8	6 - 10	< 0.001
Readmission within 30 days	2,005	8.9	1,334	9.1	511	8.6	160	8.6	0.339
90-day mortality	1,518	6.8	1,095	7.5	328	5.5	95	5.1	< 0.001

Table 2. Short-Term Outcomes by Gastrectomy Approach

All patients (N = 22,445)

Open (N = 14,598)

Laparoscopic (N = 5,980)

Robotic (N = 1,867)

P value

Median (N)

IQR (%)

Median (N)

IQR (%)

Median (N)

IQR (%)

Median (N)

IQR (%)

IQR: interquartile range.

Number of lymph nodes examined

10 - 24

10 - 23

11 - 25

12 - 27

< 0.001

20,159

89.8

12,911

88.4

5,499

92.0

1,749

93.7

< 0.001

Length of hospital stay, days

6 - 12

7 - 13

6 - 11

6 - 10

< 0.001

Readmission within 30 days

2,005

8.9

1,334

9.1

511

8.6

160

8.6

0.339

90-day mortality

1,518

6.8

1,095

7.5

328

5.5

5.1

< 0.001

**Table 3.** Trends of Patients’ Characteristics and Short-Term Surgical Outcomes of Robotic Gastrectomy
	First period (2010 - 2012) (N = 249)	Second period (2013 - 2015) (N = 586)	Third period (2016 - 2018) (N = 1,032)	P value
^aUnknown patients were excluded. IQR: interquartile range; cT: clinical T category; CCP: community cancer program; CCCP: comprehensive community cancer program; AP: academic and research program; INCP: integrated network cancer program.
Characteristics
Charlson-Deyo score ≥ 2	741	9.8	797	10.5	1,028	14.1	< 0.001
cT ≥ 3 or N+^a	3,051	60.2	3,413	63.6	2,225	65.3	< 0.001
Preoperative therapy^a	2,541	44.9	3,269	54.5	3,778	62.7	< 0.001
Facility type							< 0.001
CCP	265	3.5	232	3.0	179	2.5
CCCP	2,151	28.6	2,169	28.4	1,939	26.6
AP	3,663	48.6	3,827	50.2	3,953	54.3
INCP	1,454	19.3	1,400	18.4	1,213	16.7
Short-term outcomes
Lymph nodes examined (n)	15	9 - 22	16	10 - 24	18	12 - 26	< 0.001
R0 rate (%)	6,675	88.6	6,842	89.7	6,642	91.1	< 0.001
Length of hospital stay, days	9	7 - 13	8	6 - 12	8	6 - 11	< 0.001
Readmission within 30 days	759	10.1	670	8.8	576	7.9	< 0.001
90-day mortality (%)	550	7.3	534	7.0	434	6.0	0.003

Table 3. Trends of Patients’ Characteristics and Short-Term Surgical Outcomes of Robotic Gastrectomy

First period (2010 - 2012) (N = 249)

Second period (2013 - 2015) (N = 586)

Third period (2016 - 2018) (N = 1,032)

P value

Median (N)

IQR (%)

Median (N)

IQR (%)

Median (N)

IQR (%)

^aUnknown patients were excluded. IQR: interquartile range; cT: clinical T category; CCP: community cancer program; CCCP: comprehensive community cancer program; AP: academic and research program; INCP: integrated network cancer program.

Characteristics

Charlson-Deyo score ≥ 2

741

9.8

797

10.5

1,028

14.1

< 0.001

cT ≥ 3 or N+^a

3,051

60.2

3,413

63.6

2,225

65.3

< 0.001

Preoperative therapy^a

2,541

44.9

3,269

54.5

3,778

62.7

< 0.001

Facility type

< 0.001

CCP

265

3.5

232

3.0

179

2.5

CCCP

2,151

28.6

2,169

28.4

1,939

26.6

3,663

48.6

3,827

50.2

3,953

54.3

INCP

1,454

19.3

1,400

18.4

1,213

16.7

Short-term outcomes

Lymph nodes examined (n)

9 - 22

10 - 24

12 - 26

< 0.001

R0 rate (%)

6,675

88.6

6,842

89.7

6,642

91.1

< 0.001

Length of hospital stay, days

7 - 13

6 - 12

6 - 11

< 0.001

Readmission within 30 days

759

10.1

670

8.8

576

7.9

< 0.001

90-day mortality (%)

550

7.3

534

7.0

434

6.0

0.003

**Table 4.** Association of the Number of Lymph Nodes Examined (≥ 16) and Patient Characteristics
	Odds ratio	95% CI	P value
CI: confidence interval; CCP: community cancer program; CCCP: comprehensive community cancer program; AP: academic and research program; INCP: integrated network cancer program.
Gastrectomy approach			< 0.001
Open	Reference
Laparoscopic	1.28	1.20 - 1.36
Robotic	1.49	1.34 - 1.65
Age, years			0.905
≤ 60	Reference
> 60	1.00	0.94 - 1.07
Sex			0.196
Male	Reference
Female	1.04	0.9 - 1.11
Facility type			< 0.001
CCP	Reference
CCCP	1.29	1.09 - 1.54
AP	2.61	2.20 - 3.09
INCP	1.51	1.27 - 1.81
Surgical procedure			< 0.001
Total gastrectomy	Reference
Subtotal/distal gastrectomy	0.64	0.59 - 0.69
Proximal gastrectomy	0.78	0.72 - 0.83
Preoperative treatment			< 0.001
Upfront surgery	Reference
Chemotherapy	1.75	1.60 - 1.91
Chemoradiotherapy	0.71	0.66 - 0.78
Charlson-Deyo score			< 0.001
0	Reference
1	0.91	0.85 - 0.97
≥ 2	0.80	0.73 - 0.88
Pathologic T category			< 0.001
T0	Reference
T1	0.97	0.85 - 1.11
T2	1.00	0.86 - 1.15
T3	0.99	0.87 - 1.14
T4	0.80	0.69 - 0.94
Pathologic N category			< 0.001
N0	Reference
N1	1.12	1.02 - 1.21
N2	1.44	1.31 - 1.59
N3	4.00	3.57 - 4.49
Time period			< 0.001
First period (2010 - 2012)	Reference
Second period (2013 - 2015)	1.25	1.17 - 1.34
Third period (2016 - 2018)	1.79	1.66 - 1.93

Table 4. Association of the Number of Lymph Nodes Examined (≥ 16) and Patient Characteristics

Odds ratio

95% CI

P value

CI: confidence interval; CCP: community cancer program; CCCP: comprehensive community cancer program; AP: academic and research program; INCP: integrated network cancer program.

Gastrectomy approach

< 0.001

Open

Reference

Laparoscopic

1.28

1.20 - 1.36

Robotic

1.49

1.34 - 1.65

Age, years

0.905

≤ 60

Reference

> 60

1.00

0.94 - 1.07

Sex

0.196

Male

Reference

Female

1.04

0.9 - 1.11

Facility type

< 0.001

CCP

Reference

CCCP

1.29

1.09 - 1.54

2.61

2.20 - 3.09

INCP

1.51

1.27 - 1.81

Surgical procedure

< 0.001

Total gastrectomy

Reference

Subtotal/distal gastrectomy

0.64

0.59 - 0.69

Proximal gastrectomy

0.78

0.72 - 0.83

Preoperative treatment

< 0.001

Upfront surgery

Reference

Chemotherapy

1.75

1.60 - 1.91

Chemoradiotherapy

0.71

0.66 - 0.78

Charlson-Deyo score

< 0.001

Reference

0.91

0.85 - 0.97

≥ 2

0.80

0.73 - 0.88

Pathologic T category

< 0.001

Reference

0.97

0.85 - 1.11

1.00

0.86 - 1.15

0.99

0.87 - 1.14

0.80

0.69 - 0.94

Pathologic N category

< 0.001

Reference

1.12

1.02 - 1.21

1.44

1.31 - 1.59

4.00

3.57 - 4.49

Time period

< 0.001

First period (2010 - 2012)

Reference

Second period (2013 - 2015)

1.25

1.17 - 1.34

Third period (2016 - 2018)

1.79

1.66 - 1.93