Lower rate of conversion using robotic-assisted surgery compared to laparoscopy in completion total gastrectomy for remnant gastric cancer
Lower rate of conversion using robotic-assisted surgery compared to laparoscopy in completion total gastrectomy for remnant gastric cancer
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DOI：
10.1007/s00464-019-06838-3
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发表时间：
2020-02-01
影响因子：
3.1
通讯作者：
Hyung, Woo Jin
中科院分区：
文献类型：
--
作者：
Alhossaini, Rana M.;Altamran, Abdulaziz A.;Hyung, Woo Jin
背景：残胃癌完全性全胃切除术加根治性淋巴结切除术是一项技术要求很高的手术。以前没有研究比较腹腔镜和机器人辅助完成胃切除术，然而一些小病例系列报道了微创手术比开放手术的好处。本研究的目的是评估机器人辅助与腹腔镜完全胃切除术治疗残余胃癌的有效性和可行性。方法回顾性分析2005年4月至2017年7月在延世大学卫生系统Severance医院行微创残胃癌全胃切除术的55例患者的资料。在55名患者中，30名患者接受了腹腔镜手术，25名患者接受了机器人辅助完成全胃切除术。我们比较了患者的人口统计学、手术结果和术后结果。结果机器人辅助手术组手术时间更长（225分钟vs 292分钟，P < 0.001），但两组估计失血量相似。由于严重粘连，腹腔镜手术组有13.3%（4例）的患者转行开放手术，而机器人组没有患者转行腹腔镜或开放手术（P = 0.058）。两组的平均住院时间、术后并发症和恢复情况相似。病理结果，包括淋巴结的数量，在两组之间没有差异。结论腹腔镜和机器人入路治疗残胃癌是可行且安全的，短期疗效相当。然而，机器人方法的转换率比腹腔镜低，尽管统计差异很小。
Background Completion total gastrectomy with radical lymphadenectomy for remnant gastric cancer is a technically demanding procedure. No previous studies have compared laparoscopic to robotic-assisted completion gastrectomy, whereas a few small case series have reported benefits of minimally invasive surgery over open surgery. The aim of this study is to assess the effectiveness and feasibility of robotic-assisted compared with laparoscopic completion gastrectomy for the treatment of remnant gastric cancer. Methods We retrospectively reviewed data from 55 patients who underwent minimally invasive completion gastrectomy for remnant gastric cancer at the Severance Hospital of Yonsei University Health System from April 2005 to July 2017. Of the 55 patients, 30 patients underwent laparoscopic and 25 underwent robotic-assisted completion total gastrectomy. We compared the patients' demographics, operative outcomes, and postoperative outcomes. Results Operation time was longer in the robotic-assisted surgery group (225 vs 292 min, P < 0.001), but both groups had similar estimated blood loss. The laparoscopic surgery group had a 13.3% (four patients) rate of conversion to open surgery because of severe adhesions, whereas no patients in the robotic group underwent conversion to laparoscopic or open surgery (P = 0.058). Mean hospital stay, postoperative complications, and recovery were similar in both groups. Pathology results, including the number of retrieved lymph nodes, did not differ between groups. Conclusion Laparoscopic and robotic approaches are both feasible and safe for remnant gastric cancer, with comparable short-term outcomes. However, the robotic approach demonstrated a lower conversion rate than laparoscopy, although the statistical difference was marginal.