Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study
Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study
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DOI：
10.1007/s00464-018-06624-7
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发表时间：
2019-10-01
影响因子：
3.1
通讯作者：
Liu, Hong-Bin
中科院分区：
文献类型：
--
作者：
Wang, Wen-Jie;Li, Hong-Tao;Liu, Hong-Bin
背景机器人辅助胃切除术（RAG）已越来越多地用于治疗晚期胃癌（AGC），并且已经报道了相对于腹腔镜辅助胃切除术（LAG）的许多优点。然而，其胃切除术后并发症仍在调查中，结果仍存在争议。本研究旨在使用 Clavien-Dindo (C-D) 分类客观评估 RAG 与 LAG 后并发症的发生率和严重程度，并确定与并发症相关的危险因素。方法 2016年1月至2018年5月期间接受RAG或LAG的527例AGC患者纳入本研究。并发症根据C-D分类进行分类。使用一对一倾向评分匹配 (PSM) 分析和亚组分析比较 RAG 和 LAG 后的并发症。进行逻辑回归分析以确定与并发症相关的危险因素。结果 251 例患者（47.6%）进行了 RAG，276 例患者（52.4%）进行了 LAG。 PSM前，RAG组肿瘤体积较小（P = 0.004），且既往腹部手术患者较少（P = 0.013）。 PSM 后，对 446 名患者（每组 223 名）组成的均衡队列进行了进一步分析。有趣的是，RAG 组的总体并发症和严重并发症（C-D 级 >= IIIa）的发生率显着低于 LAG 组（总体为 24.5% vs. 18.8%，P < 0.001；严重并发症为 8.9% vs. 17.5%，P = 0.002）。亚组分析显示，大多数分层参数也存在统计学显着差异。多变量分析确定年龄 >= 65 岁、全胃切除术、T3-T4a 期、II-III 期和手术时间 >= 250 分钟作为总体并发症的独立预测因素。此外，年龄≥65岁、II-III期、手术时间≥250min被确认为严重并发症的独立危险因素。结论 RAG联合D2淋巴结清扫术治疗AGC是可行、安全的，并发症发生率低，严重程度低。
Background Robot-assisted gastrectomy (RAG) has been increasingly used for the treatment of advanced gastric cancer (AGC), and many advantages over laparoscopy-assisted gastrectomy (LAG) have been reported. However, its postgastrectomy complications still under investigation and the results remain controversial. This study aimed to objectively assess the incidence and severity of complications following RAG vs. LAG using Clavien-Dindo (C-D) classification and to identify risk factors related to complications. Methods Five hundred and twenty-seven patients with AGC who underwent RAG or LAG between January 2016 and May 2018 were enrolled in this study. Complications were categorized according to the C-D classification. The complications following RAG and LAG were compared using one-to-one propensity score matching (PSM) analysis and subgroup analyses. Logistic regression analyses were performed to identify risk factors related to complications. Results RAG was performed in 251 patients (47.6%) and LAG in 276 patients (52.4%). Before PSM, the RAG group had a smaller tumour size (P = 0.004) and less patients with previous abdominal operation (P = 0.013). After PSM, a well-balanced cohort of 446 patients (223 in each group) was further analyzed. Of interest, the incidence of overall and severe complications (C-D grade >= IIIa) following the RAG group were significantly fewer than the LAG group (overall, 24.5% vs. 18.8%, P < 0.001; severe, 8.9% vs. 17.5%, P = 0.002). Subgroup analyses showed statistically significant difference were also observed in most stratified parameters. Multivariable analysis identified age >= 65 years, total gastrectomy, stage T3-T4a, stage II-III, and operation time >= 250 min as independent predictors of overall complications. Additionally, age >= 65 years, stage II-III, and operation time >= 250 min were confirmed as independent risk factors for severe complications. Conclusions RAG with D2 lymphadenectomy is feasible and safe for the treatment of AGC in terms of the lower incidence and severity of complications.