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Robotic versus laparoscopic gastrectomy for gastric cancer: protocol for umbrella review of systematic reviews and meta-analyses
  1. Luigi Marano,
  2. Daniele Fusario,
  3. Vinno Savelli,
  4. Luigi Verre,
  5. Alessandro Neri,
  6. Daniele Marrelli,
  7. Franco Roviello
  1. Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
  1. Correspondence to Professor Luigi Marano; luigi.marano{at}


Introduction Laparoscopic surgery has been adopted in some parts of the world as an innovative approach to the resection of gastric cancers. However, in the modern era of surgical oncology, to overcome intrinsic limitations of the traditional laparoscopy, the robotic approach is advocated as able to facilitate the lymph node dissection and complex reconstruction after gastrectomy, to assure oncologic safety also in advanced gastric cancer patients. Previous meta-analyses highlighted a lower complication rate as well as bleeding in the robotic approach group when compared with the laparoscopic one. This potential benefit must be balanced against an increased time of intervention. The aim of this umbrella review is to provide a comprehensive overview of the literature for surgeons and policymakers in order to evaluate the potential benefits and harms of robotic gastrectomy (RG) compared with the laparoscopic approach for gastric cancer.

Methods and analysis We will perform a comprehensive search of the PubMed, Cochrane and Embase databases for all articles published up to May 2019 and reference list of relevant publications for systematic review and meta-analyses comparing the outcomes of RG and laparoscopic gastrectomy in patients with gastric cancer. Studies will be selected by two independent reviewers based on prespecified eligibility criteria and the quality will be assessed according to AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist. All information will be collected using piloted and standardised data-extraction forms in DistillerSR developed following the Joanna Briggs Institute’s recommended extraction items.

Ethics and dissemination This umbrella review will inform clinical and policy decisions regarding the benefits and harms of RG for treating gastric cancer. The results will be disseminated through a peer-reviewed publication, conference presentations and the popular press. Formal ethical approval is not required as primary data will not be collected.

PROSPERO registration number CRD42019139906.

  • surgery
  • adult surgery
  • gastrointestinal tumours

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  • Contributors LM and FR conceived the study. LM drafted the protocol manuscript. DF, VS, LV, DM, AN and FR revised the manuscript for important intellectual content as well as contributed to the methodology including search strategy, study selection, data extraction and data analysis. FR is the clinical lead and DM is the guarantor of the review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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