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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang's three-step maneuver for advanced upper gastric cancer: Results from a propensity score-matched study
Jia-Bin Wang, Zhi-Yu Liu, Qi-Yue Chen, Qing Zhong, Jian-Wei Xie, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Ju-Li Lin, Hua-Long Zheng, Si-Jin Que, Chao-Hui Zheng, Chang-Ming Huang, Ping Li
Jia-Bin Wang, Zhi-Yu Liu, Qi-Yue Chen, Qing Zhong, Jian-Wei Xie, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Ju-Li Lin, Hua-Long Zheng, Si-Jin Que, Chao-Hui Zheng, Chang-Ming Huang, Ping Li, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Jia-Bin Wang, Zhi-Yu Liu, Qi-Yue Chen, Qing Zhong, Jian-Wei Xie, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Ju-Li Lin, Hua-Long Zheng, Si-Jin Que, Chao-Hui Zheng, Chang-Ming Huang, Ping Li, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Chao-Hui Zheng, Chang-Ming Huang, Ping Li, Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Author contributions: Liu ZY wrote most of the manuscript and designed the study; Liu ZY, Wang JB, Zheng CH, and Chen QY collected the data and performed the statistical analysis; Chen QY, Zhong Q, Wang JB, Li P, and Zheng HL prepared the final edition version of the manuscript and designed the tables and figures; Xie JW and Lin JX provided technical support and assisted in analyzing the results; Lu J and Wang JB helped draft the manuscript; Huang ZN, Lin JL, Cao LL, Lin M, Tu RH, and Huang CM reviewed the pathological specimens; all authors read and approved the final manuscript.
Institutional review board statement: This retrospective study was approved by the Ethics Committee of Fujian Medical University Union Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ping Li, MD, PhD, Doctor, Professor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China.pingli811002@163.com
Supported by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province, China, No. 2016Y9031; the Construction Project of Fujian Province Minimally Invasive Medical Center, No. [2017]171; the Second-batch Special Support Funds for Fujian Province Innovation and Entrepreneurship Talents, No. 2016B013; Science and Technology Innovation Joint Fund Project of Fujian Province, No. 2017Y9004; and the Special Fund for Clinical Research of the Wu Jieping Medical Foundation, No. 320.6750.17511.
Telephone: +86-591-83363366 Fax: +86-591-83363366
Received: May 24, 2019
Peer-review started: May 24, 2019
First decision: June 16, 2019
Revised: July 12, 2019
Accepted: August 7, 2019
Article in press: August 7, 2019
Published online: October 7, 2019
BACKGROUND
Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.
AIM
To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy (SPSHL) for advanced gastric cancer (GC) by Huang’s three-step maneuver.
METHODS
A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017, including 35 patients who underwent robotic SPSHL (RSPSHL) and 608 who underwent laparoscopic SPSHL (LSPSHL). One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL.
RESULTS
In all, 175 patients were matched, including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL. After matching, there were no significant differences detected in the baseline characteristics between the two groups. Significant differences in total operative time, estimated blood loss (EBL), splenic hilar blood loss (SHBL), splenic hilar dissection time (SHDT), and splenic trunk dissection time were evident between these groups (P < 0.05). Furthermore, no significant differences were observed between the two groups in the overall noncompliance rate of lymph node (LN) dissection (62.9% vs 60%, P = 0.757), number of retrieved No. 10 LNs (3.1 ± 1.4 vs 3.3 ± 2.5, P = 0.650), total number of examined LNs (37.8 ± 13.1 vs 40.6 ± 13.6, P = 0.274), and postoperative complications (14.3% vs 17.9%, P = 0.616). A stratified analysis that divided the patients receiving RSPSHL into an early group (EG) and a late group (LG) revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG (P < 0.05). Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT (P < 0.05).
CONCLUSION
RSPSHL is safe and feasible, especially after overcoming the early learning curve, as this procedure results in a radical curative effect equivalent to that of LSPSHL.
Core tip: The safety and oncologic efficacy of spleen-preserving splenic hilar lymphadenectomy (SPSHL) are being evaluated, but the data are limited, especially for robotic surgery. What’s more, few previous studies have compared robotic SPSHL (RSPSHL) with laparoscopic SPSHL (LSPSHL) for gastric cancer. Huang’s three-step maneuver constitutes a set of effective surgical procedures for the SPSHL, which was proposed previously by our department. Thus, we offer a single-institution investigation on the comparative safety, feasibility, and oncologic efficacy of robotic vs laparoscopic SPSHL. It is worth noting that this is the first study that compared RSPSHL and LSPSHL using Huang’s three-step maneuver for advanced gastric cancer.
