Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy
Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy
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DOI：
10.1007/s00464-015-4069-1
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发表时间：
2015-11-01
影响因子：
3.1
通讯作者：
Hyung, Woo Jin
中科院分区：
文献类型：
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作者：
Lee, Juhan;Kim, Yoo-Min;Hyung, Woo Jin
微创手术（MIS）已成为早期胃癌的首选治疗方法。然而，将MIS应用于高体重指数（BMI）的胃患者在技术上具有挑战性，特别是在进行D2淋巴结清扫术时。最近，机器人系统已被采用，以克服传统的腹腔镜手术的技术限制。然而，缺乏关于使用机器人系统在高BMI患者中进行D2淋巴结切除术的影响的研究。因此，本研究旨在比较淋巴结切除术的质量，以及手术结果，在不同BMI状态的患者中，通过机器人远端胃大部切除术联合D2淋巴结切除术（RDGD 2）与腹腔镜远端胃大部切除术联合D2淋巴结切除术（LDGD 2）进行比较。或LDGD 2（n = 267）。根据手术方法和BMI对患者进行分类。我们比较了手术组和BMI组的临床病理特征以及短期和长期结局，无论BMI如何，RDGD 2需要的手术时间明显长于LDGD 2（p = 0.001）;同时，RDGD 2显示失血量明显少于LDGD 2（p = 0.005）。在BMI组之间，RDGD 2在超过25个淋巴结的回收率方面没有显着差异（p = 0.181）;然而，LDGD 2与高BMI患者中超过25个淋巴结的回收率显着降低相关（p = 0.006）。在高BMI患者中，不同手术入路的并发症无显著差异。同样，RDGD 2和LDGD 2显示根据BMI状态无统计学显著的生存差异。当进行远端胃大部切除术和D2淋巴结切除术时，机器人方法的益处在高BMI患者中比在正常BMI患者中更明显，特别是在失血量和淋巴结切除术质量方面。机器人手术可能是治疗高BMI胃癌患者的传统腹腔镜手术的有效替代方案。
Minimally invasive surgery (MIS) has emerged as a treatment of choice for early-stage gastric cancer. However, applying MIS to gastric patients with high body mass index (BMI) is technically challenging, especially when performing D2 lymphadenectomy. Recently, robotic systems have been adopted to overcome the technical limitations of conventional laparoscopic surgery. Nevertheless, studies on the impact of the use of robotic systems to perform D2 lymphadenectomy in high BMI patients are lacking. Accordingly, this study was designed to compare the quality of lymphadenectomy, together with surgical outcomes, by robotic distal subtotal gastrectomy with D2 lymphadenectomy (RDGD2) to those by laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy (LDGD2) in patients of different BMI status.Retrospective review of a prospectively collected database identified 400 gastric cancer patients who underwent either RDGD2 (n = 133) or LDGD2 (n = 267) between 2003 and 2010. Patients were categorized according to surgical approach and BMI. We compared clinicopathologic characteristics, as well as short-term and long-term outcomes, between surgery and BMI groups.Regardless of BMI, RDGD2 required significantly longer operation time than LDGD2 (p = 0.001); meanwhile, RDGD2 showed significantly less blood loss than LDGD2 (p = 0.005). Between BMI groups, RDGD2 showed no significant difference in the rate of retrieving more than 25 lymph nodes (p = 0.181); however, LDGD2 was associated with a significantly lower rate of retrieving more than 25 lymph nodes in high BMI patients (p = 0.006). In high BMI patients, complications did not significantly differ between surgical approaches. As well, RDGD2 and LDGD2 demonstrated no statistically significant survival difference according to BMI status.The benefits of a robotic approach were more evident in high BMI patients than in normal BMI patients when performing distal subtotal gastrectomy with D2 lymphadenectomy, particularly in terms of blood loss and consistent quality of lymphadenectomy. Robotic surgery could be an effective alternative to conventional laparoscopic surgery in treating gastric cancer patients with high BMI.