Impact of articulating laparoscopic instrument-assisted gastrectomy with D2 lymphadenectomy on perioperative and oncologic outcomes compared with conventional laparoscopy: a propensity score matching analysis.

Abstract

Background: Articulating laparoscopic instruments (ALIs) have been developed to overcome the limited dexterity afforded by conventional laparoscopic instruments (CLIs). This study aimed to compare the postoperative and oncologic outcomes of patients who underwent laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer using CLIs versus ALIs.

Methods: This retrospective study included 138 patients who underwent laparoscopic gastrectomy with D2 dissection for gastric cancer at a single institution from January 2018 to January 2024. Propensity score matching analysis was performed to minimize selection bias and compare surgical outcomes.

Results: After matching, 39 patients were included in each group. The ALI group showed significantly faster postoperative recovery, with a shorter hospital stay (4.0 [3.0-5.0] days vs. 5.0 [4.0-7.0] days, p = 0.001) and quicker time to first flatus (2.0 [2.0-3.0] days vs. 3.0 [2.0-3.0] days, p = 0.004). Although the ALI group had a shorter operative time and lower estimated blood loss, these differences were not statistically significant (p = 0.202 and p = 0.634, respectively). Complication rates, including major complications, were similar between the two groups. Long-term oncologic outcomes, including overall survival and recurrence-free survival, did not differ significantly between the groups (p = 0.622 and p = 0.756, respectively).

Conclusion: The use of ALIs in laparoscopic gastrectomy with D2 lymphadenectomy was associated with improved short-term perioperative outcomes without compromising long-term oncologic safety. These findings suggest that ALIs may enhance surgical efficiency and postoperative recovery in gastric cancer surgery.