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Chen J, Wang F, Wang Y, Zhou J, Yang Y, Zhao Z, Wu R, Wang L, Ren J. A comparison of postoperative outcomes between robotic-assisted and laparoscopic-assisted total gastrectomy: a comprehensive meta-analysis and systematic review. BMC Surg 2025; 25:212. [PMID: 40375289 PMCID: PMC12079958 DOI: 10.1186/s12893-025-02934-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 04/24/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND The application of robot-assisted technology in gastric cancer surgery is gradually gaining attention from surgeons. In this meta-analysis, our main objective was to assess whether robot-assisted techniques are more advantageous than laparoscopic-assisted technology in total gastrectomy. METHODS We searched Pubmed, Embase, Web of Science, and Cochrane Library databases for clinical studies published before October 2023 comparing robotic-assisted total gastrectomy (RATG) and laparoscopic-assisted total gastrectomy (LATG) for gastric cancer. Non-clinical studies, data unavailability, or fewer than 50 included cases were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias by determining the quality of the observational studies. Statistical meta-analysis and drawing were performed using the Software Review Manager version 5.3 and Stata version 16.0. P < 0.05 was considered significant. RESULTS Nine studies that included 1,864 patients with gastric cancer were included, published between 2012 and 2023. The results of the analysis showed that RATG has advantages in the following aspects: intraoperative blood loss was 17.69 ml lower in the RATG group than in the LATG group (WMD: -17.69,95% CI:-20.90 ∼ -14.49; P < 0.05); In terms of the number of resected lymph nodes, the RATG group had 2.65 more than the LATG group (WMD: 2.65,95% CI:0.88 ∼ -4.42); P < 0.05); the time to start liquid and postoperative hospital stays were 0.62 and 0.90 days shorter in the RATG group than in the LATG group, respectively (WMD: -0.62,95%CI: -1.06 ∼ -0.19; P < 0.05), (WMD: -0.90,95%CI: -1.43 ∼ -0.37; P < 0.05)); the incidence of major complications and pancreas fistula in the RATG group was 0.59% and 0.17% lower than in the LATG group, respectively (OR: 0.59,95% CI: 0.38 ∼ 0.93; P < 0.05), (OR: 0.17,95% CI: 0.03 ∼ 0.94; P < 0.05). However, the analysis showed that the operative time in the RATG group was 30.96 min longer than in the LATG group (WMD: 30.96,95% CI: 21.24 ∼ 40.69; P < 0.05). CONCLUSIONS Based on the results of this meta-analysis, we concluded that robotic-assisted technology may be a worthwhile technique to apply in the surgical treatment of total gastrectomy. However, this meta-analysis has the limitations that the included studies were all non-randomized controlled trials and published in Asian countries, and more high-quality randomized controlled trials are needed for further validation in the future. THE REGISTERED NAME AND REGISTRATION NUMBER The study protocol for this meta-analysis is registered on the PROSPERO website under registration number CRD42024500512.
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Affiliation(s)
- Jianhua Chen
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
- General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Fei Wang
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China
| | - Yong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Jie Zhou
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China
| | - Yapeng Yang
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Ziming Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Rongfan Wu
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Liuhua Wang
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, People's Republic of China
- General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Jun Ren
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, People's Republic of China.
- General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China.
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Yu Y, Yamauchi S, Yoshimoto Y, Yube Y, Kaji S, Fukunaga T. Laparoscopic vs robot-assisted gastrectomy in gastric cancer patients with prior abdominal surgery: a propensity-matched analysis. J Robot Surg 2025; 19:196. [PMID: 40319425 DOI: 10.1007/s11701-025-02347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Accepted: 04/16/2025] [Indexed: 05/07/2025]
Abstract
No studies have compared the efficacy of laparoscopic gastrectomy (LG) and robot-assisted gastrectomy (RG) for gastric cancer (GC) patients with a history of abdominal surgery (HAS). This is the first study in this field to identify complication-related factors and compare survival outcomes using propensity score matching (PSM) and a competing risk model (CRM). A retrospective cohort study was conducted on GC patients with HAS who underwent radical LG or RG. PSM was applied to achieve baseline balance. Univariate and multivariate regression analyses were performed to identify factors independently associated with complications. CRM adjusted by inverse probability of censoring weighting (IPCW) was used to analyze overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) across different TNM stages. PSM with a 3:1 ratio ensured baseline balance while minimizing sample loss (LG n = 87, RG n = 29). RG was associated with a significantly longer surgery duration but a lower incidence of overall and Clavien-Dindo (CD) grade ≥ 2 complications. Multivariate analysis identified RG (OR, 95% CI: 0.02, 0.01-0.15), surgery duration (OR, 95% CI: 1.01, 1.00-1.01), and lymphadenectomy extent (OR, 95% CI: 2.81, 1.16-7.25) as independent factors associated with overall complications. Likewise, RG (OR, 95% CI: 0.06, 0.01-0.38), surgery duration (OR, 95% CI: 1.01, 1.00-1.02), and tumor size (OR, 95% CI: 1.02, 1.00-1.04) were independently associated with CD grade ≥ 2 complications. Kaplan-Meier analyses based on IPCW-adjusted CRM showed no significant differences in OS, CSS, and DFS between RG and LG across TNM stages. RG may efficiently reduce complications compared to LG but offers no survival benefit, suggesting a potential advantage in perioperative safety for GC patients with HAS.
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Affiliation(s)
- Yang Yu
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
- Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Rd, Haidian District, Beijing, 100142, China
| | - Suguru Yamauchi
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
- Department of Surgery, Johns Hopkins University School of Medicine, 1650 Orleans Street, Baltimore, MD, 21287, USA
| | - Yutaro Yoshimoto
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
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Nishi M, Takasu C, Wada Y, Tokunaga T, Kashihara H, Ishikawa D, Yoshimoto T, Nakasu C, Shimada M. Surgical Technique of Robotic Distal Gastrectomy for Gastric Cancer Using the Hinotori Surgical System. Surg Laparosc Endosc Percutan Tech 2025:00129689-990000000-00315. [PMID: 40195696 DOI: 10.1097/sle.0000000000001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Accepted: 03/17/2025] [Indexed: 04/09/2025]
Abstract
AIM The da Vinci Surgical System (Intuitive Surgical) currently dominates robotic gastrectomy for gastric cancer. The hinotori Surgical Robot System (Medicaroid Corporation) is a newly developed, Japan-made surgical assist robot. This study aimed to introduce the initial experience of robotic gastrectomy using the hinotori and discuss key techniques and challenges. METHODS This single-center retrospective study involved 10 eligible patients who underwent curative robotic distal gastrectomy using the hinotori for primary Stage I to III gastric cancer. Short-term surgical outcomes were evaluated. Lymph node dissection was mainly performed using the conventional double bipolar technique, left-handed double bipolar technique, or laparoscopic coagulation shears from the assist port. RESULTS No patients developed intraoperative complications, and all procedures were successfully completed without conversion to open or laparoscopic surgery. All patients achieved R0 resection. The median operation time was 275 minutes (range, 252 to 336 min), and the estimated blood loss was 5 mL (range, 3 to 20 mL). The drain amylase content on postoperative day 1 was 220.5 IU/L (range, 66 to 1207 IU/L). The median number of retrieved lymph nodes was 29.5 (range, 11 to 58). No patients developed postoperative Clavien-Dindo grade ≥IIIa complications, and there was no mortality. CONCLUSION Robotic gastrectomy using the hinotori shows potential benefits for gastric cancer. Further studies are needed to validate these advantages.
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Affiliation(s)
- Masaaki Nishi
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
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Crafa FM, Vanella S, Caruso E, Coppola Bottazzi E, Noviello A, Amendola A. Robotic subtotal D2-gastrectomy for gastric cancer after right hemiliver transplantation: case report and literature review. Acta Chir Belg 2025; 125:33-39. [PMID: 39319792 DOI: 10.1080/00015458.2024.2406603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND With the progress achieved in transplant surgeries an improved long-term survival of patients is obtained due to more effective immunosuppressant therapy. De novo malignancy (DNM) has gained interest in this group of patients. DNM is a major cause of late mortality after liver transplantation. METHODS We report the case of a patient who underwent orthotopic liver transplantation with right hemiliver (right split) 18 years ago who came to our attention for gastric cancer. We performed a robotic subtotal gastrectomy D2 lymphadenectomy with manual latero lateral trans mesocolic BII gastro jejunal anastomosis using da Vinci robotic surgery system at our hospital. RESULTS The operation was successful, the operative time was 230 min, the intraoperative blood loss was 100 ml. The patient was discharged on day 8 after surgery, and no complications occurred. Postoperative pathological stages were pT2 N0 (0/25). During the follow-up period, the patient was in good health without long-term complications. CONCLUSION Robotic approach is feasible in patients after liver transplantation.
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Affiliation(s)
- Francesco Maria Crafa
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino, Italy
| | - Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino, Italy
| | - Emanuele Caruso
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino, Italy
| | - Enrico Coppola Bottazzi
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino, Italy
| | - Adele Noviello
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino, Italy
| | - Alfonso Amendola
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino, Italy
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Ma Y, Deng Y, Wan H, Ma D, Ma L, Fan W, Liu J, Hu M, Fan R, Ma Y. Construction and validation of a nomogram prediction model for the occurrence of complications in patients following robotic radical surgery for gastric cancer. Langenbecks Arch Surg 2025; 410:54. [PMID: 39873792 DOI: 10.1007/s00423-024-03594-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 12/22/2024] [Indexed: 01/30/2025]
Abstract
BACKGROUND In the last two decades, robotic-assisted gastrectomy has become a widely adopted surgical option for gastric cancer (GC) treatment. Despite its popularity, postoperative complications can significantly deteriorate patient quality of life and prognosis. Therefore, identifying risk factors for these complications is crucial for early detection and intervention. OBJECTIVE This research is designed to construct and validate a predictive model for assessing the risk of postoperative complications in patients undergoing robotic-assisted radical gastrectomy. METHODS A retrospective analysis was conducted on 500 GC patients from Gansu Provincial People's Hospital between December 2016 and October 2023. These patients formed the training cohort. An additional 136 patients from the 940th Hospital of Joint Logistic Support Force, the Chinese People's Liberation Army as the external validation cohort. Patients were categorized into groups with and without complications. Data collected included demographic details, laboratory results, CT quantitative body composition analysis, and clinical information. Variable selection was conducted through Lasso regression, succeeded by multivariable logistic regression to pinpoint independent risk factors. These elements facilitated the construction of a nomogram for prediction. The model's performance underwent internal validation via bootstrap techniques and external validation through a validation cohort. The efficacy of the model was quantified by the area under the receiver operating characteristic (ROC) curve (AUC), evaluated for calibration using calibration curves and the Hosmer-Lemeshow test, and assessed for clinical utility through decision curve analysis (DCA). RESULTS Of the 500 patients in the training cohort, 65 experienced complications, a rate of 13%. The validation cohort had a similar complication rate of 13.24% (18 out of 136 patients). Independent risk factors identified included tumor diameter (OR = 1.99, 95% CI = 1.07-3.73), TNM stage III (OR = 2.12, 95% CI = 1.03-4.36), ASA class I (OR = 0.26, 95% CI = 0.13-0.53), ASA class III (OR = 4.75, 95% CI = 2.12-10.62), and visceral fat area (VFA) (OR = 2.52, 95% CI = 1.10-5.79). The nomogram demonstrated good discrimination (AUC = 0.81, 95% CI: 0.76-0.87) in internal validation and (AUC = 0.79, 95% CI: 0.67-0.90) in external validation. Both validations confirmed the model's accurate calibration and significant clinical utility, with net benefits observed at probability thresholds ranging from 2 to 79% and 2-71%. CONCLUSION The developed nomogram, based on five independent risk factors-tumor diameter, TNM stage III, ASA class I, ASA class III, and VFA-effectively predicts the risk of complications in patients undergoing robotic-assisted radical gastrectomy, offering a valuable tool for clinical decision-making.
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Affiliation(s)
- Yuqi Ma
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yuan Deng
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Haohao Wan
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Diaolong Ma
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Liang Ma
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Wanqi Fan
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - JiXiang Liu
- Department of Medicine, Northwest University for Nationalities, Lanzhou, 730000, China
| | - Ming Hu
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - RuiFang Fan
- Department of General Surgery, the 940th Hospital of Joint Logistic Support Force, Chinese People's Liberation Army, Lanzhou, Gansu Province, China
| | - YunTao Ma
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Hwang J, Kim KY, Park SH, Cho M, Kim YM, Kim HI, Hyung WJ. Long-term Oncologic Outcomes of Robotic Total Gastrectomy for Advanced Gastric Cancer. J Gastric Cancer 2024; 24:451-463. [PMID: 39375059 PMCID: PMC11471327 DOI: 10.5230/jgc.2024.24.e38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/22/2024] [Accepted: 09/11/2024] [Indexed: 10/09/2024] Open
Abstract
PURPOSE Although laparoscopic distal gastrectomy has rapidly replaced open distal gastrectomy, laparoscopic total gastrectomy (LTG) is less frequently performed owing to technical difficulties. Robotic surgery could be an appropriate minimally invasive alternative to LTG because it alleviates the technical challenges posed by laparoscopic procedures. However, few studies have compared the oncological safety of robotic total gastrectomy (RTG) with that of LTG, especially for advanced gastric cancer (AGC). Herein, we aimed to assess the oncological outcomes of RTG for AGC and compare them with those of LTG. MATERIALS AND METHODS We retrospectively reviewed 147 and 204 patients who underwent RTG and LTG for AGC, respectively, between 2007 and 2020. Long-term outcomes were compared using inverse probability of treatment weighting (IPTW). RESULTS After IPTW, the 2 groups exhibited similar clinicopathological features. The 5-year overall survival was comparable between the 2 groups (88.5% [95% confidence interval {CI}, 79.4%-93.7%] after RTG and 87.3% [95% CI, 80.1%-92.0%]) after LTG; log-rank P=0.544). The hazard ratio (HR) for death after RTG compared with that after LTG was 0.73 (95% CI, 0.40-1.33; P=0.304). The 5-year relapse-free survival was also similar between the 2 groups (75.7% [95% CI, 65.2%-83.4%] after RTG and 76.4% [95% CI, 67.9%-83.0%] after LTG; log-rank P=0.850). The HR for recurrence after RTG compared with that after LTG was 0.93 (95% CI, 0.60-1.46; P=0.753). CONCLUSIONS Our findings revealed that RTG and LTG for AGC had similar long-term outcomes. RTG is an oncologically safe alternative to LTG and has technical advantages.
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Affiliation(s)
- Jawon Hwang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Faculty Surgery No. 1, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
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Ye SP, Wu C, Zou RX, Liu DN, Yu HX, Duan JY, Li TY. Short-term outcomes of totally robotic versus robotic-assisted distal gastrectomy for gastric cancer: a single-center retrospective study. World J Surg Oncol 2024; 22:230. [PMID: 39232702 PMCID: PMC11373196 DOI: 10.1186/s12957-024-03484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 07/17/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Totally robotic distal gastrectomy (TRDG) is being used more and more in gastric cancer (GC) patients. The study aims to evaluate the short-term efficacy of TRDG and robotic-assisted distal gastrectomy (RADG) in the treatment of GC. METHODS We retrospectively collected the clinical data of patients who underwent TRDG or RADG, of which 60 patients were included in the study: 30 cases of totally robotic and 30 cases of robotic-assisted. The short-term efficacy of the two groups was compared. RESULTS There was no significant difference in the clinicopathological data between the two groups. Compared to RADG, TRDG had less intraoperative blood loss(P = 0.019), less postoperative abdominal drainage(P = 0.031), shorter time of exhaust( P = 0.001) and liquid diet(P = 0.001), shorter length of incision(P<0.01), shorter postoperative hospital stays(P = 0.033), lower postoperative C-reactive protein(CRP)(P = 0.024) and lower postoperative Visual Analogue Scale(VAS) scores(P = 0.048). However, no significant statistical differences were found in terms of total operation time(P = 0.108), number of lymph nodes retrieved(P = 0.307), time for anastomosis(P = 0.450), proximal resection margin(P = 0.210), distal resection margin(P = 0.202), postoperative complication(P = 0.506), total hospital cost(P = 0.286) and postoperative white blood cell(WBC)(P = 0.113). CONCLUSIONS In terms of security and technology, TRDG could serve as a better treatment method for GC.
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Affiliation(s)
- Shan-Ping Ye
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Can Wu
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Rui-Xiang Zou
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Dong-Ning Liu
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Hong-Xin Yu
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Jin-Yuan Duan
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Tai-Yuan Li
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China.
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Xue Z, Lu J, Lin J, Xu KX, Xu BB, Wu D, Zheng HL, Xie JW, Wang JB, Lin JX, Chen QY, Li P, Huang CM, Zheng CH. Enlightenment of robotic gastrectomy from 527 patients with gastric cancer in the minimally invasive era: 5 years of optimizing surgical performance in a high-volume center - a retrospective cohort study. Int J Surg 2024; 110:5605-5614. [PMID: 38775618 PMCID: PMC11392220 DOI: 10.1097/js9.0000000000001652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/08/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Learning curves have been used in the field of robotic gastrectomy (RG). However, it should be noted that the previous study did not comprehensively investigate all changes related to the learning curve. This study aims to establish a learning curve for radical RG and evaluate its effect on the short-term outcomes of patients with gastric cancer. METHODS The clinicopathological data of 527 patients who underwent RG between August 2016 and June 2021 were retrospectively analyzed. Learning curves related to the operation time and postoperative hospital stay were determined separately using cumulative sum (CUSUM) analysis. Then, the impact of the learning curve on surgical efficacy was analyzed. RESULTS Combining the CUSUM curve break points and technical optimization time points, the entire cohort was divided into three phases (patients 1-100, 101-250, and 251-527). The postoperative complication rate and postoperative recovery time tended to decrease significantly with phase advancement ( P <0.05). More extraperigastric examined lymph nodes (LN) were retrieved in phase III than in phase I (I vs. III, 15.12±6.90 vs. 17.40±7.05, P =0.005). The rate of LN noncompliance decreased with phase advancement. Textbook outcome (TO) analysis showed that the learning phase was an independent factor in TO attainment ( P <0.05). CONCLUSION With learning phase advancement, the short-term outcomes were significantly improved. It is possible that our optimization of surgical procedures could have contributed to this improvement. The findings of this study facilitate the safe dissemination of RG in the minimally invasive era.
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Affiliation(s)
- Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Kai-Xiang Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
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Oh SE, Choi MG, Lee JH, Sohn TS, Bae JM, An JY. Feasibility of robotic total gastrectomy for patients with gastric cancer: A single-center retrospective cohort study of short-term outcomes. Curr Probl Surg 2024; 61:101524. [PMID: 39098334 DOI: 10.1016/j.cpsurg.2024.101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Sung Eun Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Wei LH, Zheng HL, Xue Z, Xu BB, Zheng HH, Shen LL, Zheng ZW, Xie JW, Zheng CH, Huang CM, Chen QY, Li P. Robotic gastrectomy was reliable option for overweight patients with gastric cancer: a propensity score matching study. Surg Endosc 2024; 38:3156-3166. [PMID: 38627257 DOI: 10.1007/s00464-024-10845-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/02/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The role of minimally invasive surgery using robotics versus laparoscopy in resectable gastric cancer patients with a high body mass index (BMI) remains controversial. METHODS A total of 482 gastric adenocarcinoma patients with BMI ≥ 25 kg/m2 who underwent minimally invasive radical gastrectomy between August 2016 and December 2019 were retrospectively analyzed, including 109 cases in the robotic gastrectomy (RG) group and 321 cases in the laparoscopic gastrectomy (LG) group. Propensity score matching (PSM) with a 1:1 ratio was performed, and the perioperative outcomes, lymph node dissection, and 3-year overall survival (OS) and disease-free survival (DFS) rates were compared. RESULTS After PSM, 109 patients were included in each of the RG and LG groups, with balanced baseline characteristics. Compared with the LG group, the RG group had similar intraoperative estimated blood loss [median (IQR) 30 (20-50) vs. 35 (30-59) mL, median difference (95%CI) - 5 (- 10 to 0)], postoperative complications [13.8% vs. 18.3%, OR (95%CI) 0.71 (0.342 to 1.473)], postoperative recovery, total harvested lymph nodes [(34.25 ± 13.43 vs. 35.44 ± 14.12, mean difference (95%CI) - 1.19 (- 4.871 to 2.485)] and textbook outcomes [(81.7% vs. 76.1%, OR (95%CI) 1.39 (0.724 to 2.684)]. Among pathological stage II-III patients receiving chemotherapy, the initiation of adjuvant chemotherapy in the RG group was similar to that in the LG group [median (IQR): 28 (25.5-32.5) vs. 32 (27-38.5) days, median difference (95%CI) - 3 (- 6 to 0)]. The 3-year OS (RG vs. LG: 80.7% vs. 81.7%, HR = 1.048, 95%CI 0.591 to 1.857) and DFS (78% vs. 76.1%, HR = 0.996, 95%CI 0.584 to 1.698) were comparable between the two groups. CONCLUSION RG conferred comparable lymph node dissection, postoperative recovery, and oncologic outcomes in a selected cohort of patients with BMI ≥ 25 kg/m2.
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Affiliation(s)
- Ling-Hua Wei
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Hong-Hong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Zhi-Wei Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China.
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China.
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Lu J, Xu BB, Zheng HL, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Yao ZH, Zheng CH, Huang CM. Robotic versus laparoscopic distal gastrectomy for resectable gastric cancer: a randomized phase 2 trial. Nat Commun 2024; 15:4668. [PMID: 38821945 PMCID: PMC11143299 DOI: 10.1038/s41467-024-49013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
Robotic surgery may be an alternative to laparoscopic surgery for gastric cancer (GC). However, randomized controlled trials (RCTs) reporting the differences in survival between these two approaches are currently lacking. From September 2017 to January 2020, 300 patients with cT1-4a and N0/+ were enrolled and randomized to either the robotic (RDG) or laparoscopic distal gastrectomy (LDG) group (NCT03313700). The primary endpoint was 3-year disease-free survival (DFS); secondary endpoints reported here are the 3-year overall survival (OS) and recurrence patterns. The remaining secondary outcomes include intraoperative outcomes, postoperative recovery, quality of lymphadenectomy, and cost differences, which have previously been reported. There were 283 patients in the modified intention-to-treat analysis (RDG group: n = 141; LDG group: n = 142). The trial has met pre-specified endpoints. The 3-year DFS rates were 85.8% and 73.2% in the RDG and LDG groups, respectively (p = 0.011). Multivariable Cox regression model including age, tumor size, sex, ECOG PS, lymphovascular invasion, histology, pT stage, and pN stage showed that RDG was associated with better 3-year DFS (HR: 0.541; 95% CI: 0.314-0.932). The RDG also improved the 3-year cumulative recurrence rate (RDG vs. LDG: 12.1% vs. 21.1%; HR: 0.546, 95% CI: 0.302-0.990). Compared to LDG, RDG demonstrated non-inferiority in 3-year DFS rate.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Zi-Hao Yao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China.
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Xie J, Yang J, Wang M, Yin Y, Yan Z. Robotic distal gastrectomy using a novel pre-emptive supra-pancreatic approach without duodenal transection in the dissection of D2 lymph nodes for gastric cancer. Front Oncol 2024; 14:1388626. [PMID: 38863643 PMCID: PMC11165139 DOI: 10.3389/fonc.2024.1388626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/19/2024] [Indexed: 06/13/2024] Open
Abstract
Background Robot-assisted surgery has shown remarkable progress as a minimally invasive procedure for gastric cancer. This study aimed to compare the pre-emptive suprapancreatic approach without duodenal transection and the conventional approach in terms of perioperative feasibility and short-term surgical outcomes. Methods We retrospectively analyzed all patients who underwent robotic distal gastrectomy with D2 lymph node dissection using the da Vinci Xi robotic system between December 2021 and April 2023 and categorized them into two groups for comparison. Patients treated using the pre-emptive suprapancreatic approach (observation group) were compared with those who received the conventional approach (control group). Employing one-to-one propensity score matching, we evaluated the postoperative morbidity and short-term outcomes in these two distinct groups to assess the efficacy and safety of the novel surgical technique. Results This study enrolled 131 patients: 70 in the observation group and 61 in the control group. After propensity score matching, the operative times were significantly longer in the control group than in the observation group (229.10 ± 33.96 vs. 174.84 ± 18.37, p <0.001). The mean blood loss was lower in the observation group than in the control group (25.20 ± 11.18 vs. 85.00 ± 38.78, p <0.001). Additionally, the observation group exhibited a higher number of retrieved lymph nodes, including suprapyloric, perigastric, and superior pancreatic lymph nodes (28.69 ± 5.48 vs. 19.21 ± 2.89, p <0.001; 4.98 ± 1.27 vs. 4.29 ± 1.21, p = 0.012; 10.52 ± 2.39 vs. 5.50 ± 1.62, p <0.001; 6.26 ± 2.64 vs. 5.00 ± 1.72, p = 0.029). Drain amylase levels in the observation group were significantly lower than those in the control group (30.08 ± 33.74 vs. 69.14 ± 66.81, p <0.001). Conclusion This study revealed that using the pre-emptive suprapancreatic approach without duodenal transection in the dissection of D2 lymph nodes for gastric cancer is a safe and feasible procedure in terms of surgical outcomes.
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Affiliation(s)
| | | | | | | | - Zhilong Yan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
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Jian C, Huang X, Lin R, Yang W, Zheng S, He H, Jin S, Yang C, Guan S. Robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) for the treatment of gastric gastrointestinal stromal tumors in challenging anatomical locations: single-center experience. Front Surg 2024; 11:1391387. [PMID: 38846924 PMCID: PMC11153673 DOI: 10.3389/fsurg.2024.1391387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/17/2024] [Indexed: 06/09/2024] Open
Abstract
Background Gastric gastrointestinal stromal tumors in challenging anatomical locations are difficult to remove. Methods This study retrospectively analyzed the clinical data of 12 patients with gastric GISTs in challenging anatomical locations who underwent robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) and manual suturing of the gastric wall. Results This study included 12 patients with a mean age of 56.8 ± 9.8 years and a mean BMI of 23.9 ± 1.9 kg/m2. Tumors were located in the GEJ (n = 3), lesser curvature (n = 3), posterior gastric wall (n = 3) and antrum (n = 3). The cardia and pylorus were successfully preserved in all patients regardless of the tumor location. The mean tumor size was 4.5 ± 1.4 cm. The mitotic-count/50 mm2 was less than 5 in all patients (100%). There was no intraoperative tumor rupture (0%) and no conversion to open surgery (0%). The median operation time was 122 (97-240) min, and the median blood loss volume was 10 (5-30) ml. The median postoperative VAS score was 2 (2-4). The median time to first flatus was 2 (2-3) days. The median time to first fluid intake was 2 (2-3) days. The median time to first ambulation after the operation was 3 (2-4) days. No cases of anastomotic stenosis or leakage were found. The median time to drain removal for 6 patients was 5 (4-7) days. The median time to nasogastric tube removal for all patients was 2 (1-5) days. The median postoperative hospital stay was 5 (4-8) days. One patient (female/41 year) developed moderate anemia (Clavien-Dindo grade II complication). There was no unplanned readmission within 30 days after the operation. The median distance from the tumor to the resection margin was 1 (1-2) cm. R0 resection was achieved in all patients. The median follow-up period was 19 (10-25) months, and all patients survived with no recurrence or metastasis. Conclusions RALE-PG is a safe, feasible and advantageous technique for treating GISTs in challenging anatomical locations. It can be used to accurately remove the tumor while preserving gastric function to the greatest extent, but long-term oncologic outcomes need to be evaluated in a study with a larger sample size and longer follow-up period.
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Affiliation(s)
- Chenxing Jian
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Department of Anorectal Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Xinxiang Huang
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Ruirong Lin
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Weijin Yang
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shiyao Zheng
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Hongxin He
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shangkun Jin
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Chunkang Yang
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shen Guan
- Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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14
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Lu J, Li TY, Zhang L, Wang ZK, She JJ, Jia BQ, Qin XG, Ren SY, Yao HL, Huang ZN, Liu DN, Liang H, Shi FY, Li P, Li BP, Zhang XS, Liu KJ, Zheng CH, Huang CM. Comparison of Short-term and Three-year Oncological Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Large Multicenter Cohort Study. Ann Surg 2024; 279:808-817. [PMID: 38264902 DOI: 10.1097/sla.0000000000006215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To compare the short-term and long-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. BACKGROUND The clinical outcomes of RG over LG have not yet been effectively demonstrated. METHODS This retrospective cohort study included 3599 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals in China from January 2015 to June 2019. Propensity score matching was performed between patients who received RG and LG. The primary end point was 3-year disease-free survival (DFS). RESULTS After 1:1 propensity score matching, 1034 pairs of patients were enrolled in a balanced cohort for further analysis. The 3-year DFS in the RG and LG was 83.7% and 83.1% ( P =0.745), respectively, and the 3-year overall survival was 85.2% and 84.4%, respectively ( P =0.647). During 3 years of follow-up, 154 patients in the RG and LG groups relapsed (cumulative incidence of recurrence: 15.0% vs 15.0%, P =0.988). There was no significant difference in the recurrence sites between the 2 groups (all P >0.05). Sensitivity analysis showed that RG had comparable 3-year DFS (77.4% vs 76.7%, P =0.745) and overall survival (79.7% vs 78.4%, P =0.577) to LG in patients with advanced (pathologic T2-4a) disease, and the recurrence pattern within 3 years was also similar between the 2 groups (all P >0.05). RG had less intraoperative blood loss, lower conversion rate, and shorter hospital stays than LG (all P >0.05). CONCLUSIONS For resectable gastric cancer, including advanced cases, RG is a safe approach with comparable 3-year oncological outcomes to LG when performed by experienced surgeons.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Tai-Yuan Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Zu-Kai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jun-Jun She
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bao-Qing Jia
- Department of General Surgery, The First Medical Centre, PLA General Hospital, Beijing, China
| | - Xin-Gan Qin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shuang-Yi Ren
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hong-Liang Yao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Dong-Ning Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Han Liang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Fei-Yu Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Peng Li
- Department of General Surgery, The First Medical Centre, PLA General Hospital, Beijing, China
| | - Bo-Pei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin-Sheng Zhang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Kui-Jie Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
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Zheng ZW, Lin M, Zheng HL, Chen QY, Lin JX, Xue Z, Xu BB, Li JT, Wei LH, Zheng HH, Lin J, Wang FH, Shen LL, Li WF, Zhang LK, Huang CM, Li P. Comparison of Short-Term Outcomes After Robotic Versus Laparoscopic Radical Gastrectomy for Advanced Gastric Cancer in Elderly Individuals: A Propensity Score-Matching Study. Ann Surg Oncol 2024; 31:2679-2688. [PMID: 38142258 DOI: 10.1245/s10434-023-14808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/07/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Robotic gastrectomy (RG) has been widely used to treat gastric cancer. However, whether the short-term outcomes of robotic gastrectomy are superior to those of laparoscopic gastrectomy (LG) for elderly patients with advanced gastric cancer has not been reported. METHODS The study enrolled of 594 elderly patients with advanced gastric cancer who underwent robotic or laparoscopic radical gastrectomy. The RG cohort was matched 1:3 with the LG cohort using propensity score-matching (PSM). RESULTS After PSM, 121 patients were included in the robot group and 363 patients in the laparoscopic group. Excluding the docking and undocking times, the operation time of the two groups was similar (P = 0.617). The RG group had less intraoperative blood loss than the LG group (P < 0.001). The time to ambulation and first liquid food intake was significantly shorter in the RG group than in the LG group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P = 0.14). Significantly more lymph nodes were dissected in the RG group than in the LG group (P = 0.001). Postoperative adjuvant chemotherapy was started earlier in the RG group than in the LG group (P = 0.02). CONCLUSIONS For elderly patients with advanced gastric cancer, RG is safe and feasible. Compared with LG, RG is associated with less intraoperative blood loss; a faster postoperative recovery time, allowing a greater number of lymph nodes to be dissected; and earlier adjuvant chemotherapy.
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Affiliation(s)
- Zhi-Wei Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jin-Tao Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ling-Hua Wei
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Hong-Hong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Fu-Hai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Wen-Feng Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ling-Kang Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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Lu J, Wu D, Huang JB, Lin J, Xu BB, Xue Z, Zheng HL, Lin GS, Shen LL, Li P, Wang JB, Lin JX, Chen QY, Cao LL, Xie JW, Zheng CH, Huang CM. Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation. Surg Endosc 2023; 37:7472-7485. [PMID: 37395806 DOI: 10.1007/s00464-023-10147-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/20/2023] [Indexed: 07/04/2023]
Abstract
IMPORTANCE It is largely unclear whether robotic distal gastrectomy (RDG) is cost-effective for locally advanced gastric cancer (LAGC). OBJECTIVE To evaluate the cost-effectiveness of RDG, laparoscopic distal gastrectomy (LDG), and open distal gastrectomy (ODG) for patients with LAGC. DESIGN, SETTING, AND PARTICIPANTS Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. A decision-analytic model was constructed to evaluate the cost-effectiveness of RDG, LDG, and ODG. EXPOSURES RDG, LDG, and ODG. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER) and quality-adjusted life year (QALY). RESULTS This pooled analysis of two randomized controlled trials included 449 patients: 117, 254, and 78 patients in the RDG, LDG, and ODG groups, respectively. After IPTW, RDG demonstrated its priority in terms of less blood loss, postoperative length, and complication rate (all P < 0.05). RDG also showed higher QOL with more cost, representing an ICER of $85,739.73 per QALY and $42,189.53 per QALY compared to LDG and ODG, respectively. In probabilistic sensitivity analysis, RDG achieved the best cost-effectiveness for patients with LAGC only when the willingness-to-pay threshold was > $85,739.73 per QALY, which significantly exceeded 3 times Chinese per capita GDP. Furthermore, one of the most important factors was the indirect costs of robotic surgery in terms of the cost-effectiveness of RDG compared to that of LDG or ODG. CONCLUSIONS AND RELEVANCE Although improved short-term outcomes and QOL were seen in patients underwent RDG, the economic burden should be considered in the clinical decision-making regarding robotic surgery use for patients with LAGC. Our findings may vary in different health care settings and affordability. Trial registration CLASS-01 trial (ClinicalTrials.gov, CT01609309) and FUGES-011 trial (ClinicalTrials.gov, NCT03313700).
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiao-Bao Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Choi S, Kim NY, Kim YN, Park SH, Kim KY, Cho M, Kim YM, Hyung WJ, Kim HI. Fluorescence-guided Two-port Robotic Gastrectomy Versus Conventional Laparoscopic Gastrectomy: A Nonrandomized Controlled Trial. ANNALS OF SURGERY OPEN 2023; 4:e318. [PMID: 37746613 PMCID: PMC10513269 DOI: 10.1097/as9.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/16/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To compare the number of retrieved lymph nodes between conventional laparoscopic gastrectomy (CLG) and robotic gastrectomy integrated with fluorescence guidance and a two-port system (integrated robotic gastrectomy, IRG). Background The benefits of robotic surgery over laparoscopic surgery for gastric cancer have not yet been established. Using built-in features of robotic system, further benefit can be provided to the patients with effective lymphadenectomy and enhanced recovery. Methods A nonrandomized controlled trial was performed by a single surgeon at single-center, tertiary referral hospital between January 2018 and October 2021. Overall, 140 patients scheduled to undergo minimally invasive subtotal gastrectomy for early gastric cancer were enrolled. The primary endpoint was the number of retrieved lymph nodes. Secondary endpoints were complications, hospital stay, pain score, body image, and operative cost. Results This study analyzed 124 patients in the per-protocol group (IRG, 64; CLG, 60). The number of retrieved lymph nodes was higher in the IRG group than those in the CLG group (IRG vs CLG; 42.1 ± 17.9 vs 35.1 ± 14.6, P = 0.019). Moreover, other surgical parameters, such as hospital stay (4.1 ± 1.0 vs 5.2 ± 1.8, P < 0.001) and body image scale (better in 4 of the 10 questions), were significantly better in the IRG than in the CLG. Conclusions Robotic surgical procedures integrated with fluorescence guidance and a reduced-port system yielded more retrieved lymph nodes. In addition, the IRG group showed better perioperative surgical outcomes, particularly regarding the length of hospital stay and postoperative body image. Trial registration NCT03396354.
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Affiliation(s)
- Seohee Choi
- From the Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Na Young Kim
- Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youn Nam Kim
- Department of Biostatistics, Anne Consulting, Seoul, Republic of Korea
| | - Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
- Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
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18
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Liang W, Huang J, Song L, Cui H, Yuan Z, Chen R, Zhang P, Zhang Q, Wang N, Cui J, Wei B. Five-year long-term comparison of robotic and laparoscopic gastrectomy for gastric cancer: a large single-center cohort study. Surg Endosc 2023:10.1007/s00464-023-10125-7. [PMID: 37208483 DOI: 10.1007/s00464-023-10125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/08/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Robotic gastrectomy (RG) has been reported to be technically feasible and safe for patients with gastric cancer. However, 5-year long-term survival and recurrence outcomes for advanced gastric cancer have rarely been reported. This study aimed to compare the long-term oncologic outcomes between RG and laparoscopic gastrectomy (LG) for gastric cancer. METHODS The general clinicopathological data of 1905 consecutive patients who underwent RG and LG were retrospectively collected at the Chinese People's Liberation Army General Hospital between November 2011 and October 2017. Propensity score matching (PSM) was used to match groups. The primary endpoints were 5-year disease-free survival (DFS) and overall survival (OS). RESULTS After PSM, a well-balanced cohort of 283 patients in the RG group and 701 patients in the LG group were included in the analysis. The 5-year cumulative DFS rates were 67.28% in the robotic group and 70.41% in the laparoscopic group. The 5-year OS rate was 69.01% in the robotic group and 69.58% in the laparoscopic group. No significant differences in Kaplan-Meier survival curves for DFS (HR = 1.08, 95% CI 0.83-1.39, Log-rank P = 0.557) and OS (HR = 1.02, 95% CI 0.78-1.34, Log-rank P = 0.850) were observed between the 2 groups. In the subgroup analyses for potential confounding variables, there were no significant differences in 5-year DFS and 5-year OS survival between the 2 groups (P > 0.05), except for patients with pathological stage III and pathological stage N3 (P < 0.05). CONCLUSION For patients with early gastric cancer, robotic and laparoscopic approaches have similar long-term survival. For patients with advanced gastric cancer, further studies need to be conducted to assess the long-term survival outcomes of RG.
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Affiliation(s)
- Wenquan Liang
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Jun Huang
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, China
| | - Liqiang Song
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, China
| | - Hao Cui
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yuan
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, China
| | - Runkai Chen
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Peixuan Zhang
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Qingpeng Zhang
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Ning Wang
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Jianxin Cui
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
- Medical School of Chinese PLA, Beijing, 100853, China.
| | - Bo Wei
- Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
- School of Medicine, Nankai University, Tianjin, China.
- Medical School of Chinese PLA, Beijing, 100853, China.
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Nishi M, Wada Y, Yoshikawa K, Takasu C, Tokunaga T, Nakao T, Kashihara H, Yoshimoto T, Shimada M. Utility of robotic surgery for Siewert type II/III adenocarcinoma of esophagogastric junction: transhiatal robotic versus laparoscopic approach. BMC Surg 2023; 23:128. [PMID: 37194030 DOI: 10.1186/s12893-023-02045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/12/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Robotic surgery (RS) has been rapidly adopted for gastric cancer and adenocarcinoma of the esophagogastric junction (AEG). However, the utility of RS for Siewert type II/III AEG remains unclear. METHODS Forty-one patients who underwent either transhiatal RS (n = 15) or laparoscopic surgery (LS) (n = 26) for Siewert type II/III AEG were enrolled in this study. The surgical outcomes of the two groups were compared. RESULTS In the entire cohort, there were no significant intergroup differences in the operative time, blood loss volume, or number of retrieved lymph nodes. The length of the postoperative hospital stay was shorter in the RS group than in the LS group (14.20 ± 7.10 days vs. 18.73 ± 17.82 days, respectively; p = 0.0388). The morbidity rate (Clavien-Dindo grade ≥ 2) was similar between the groups. In the Siewert II cohort, there were no significant intergroup differences in short-term outcomes. In the entire cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (91.67% vs. 91.48%, N.S.) or 3-year disease-free survival rate (91.67% vs. 91.78%, N.S.), respectively. Likewise, in the Siewert type II cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (80.00% vs. 93.33%, N.S.) or 3-year disease-free survival rate (80.00% vs. 94.12%, N.S.), respectively. CONCLUSIONS Transhiatal RS for Siewert II/III AEG was safe and contributed to similar short-term and long-term outcomes compared with LS.
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Affiliation(s)
- Masaaki Nishi
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan.
| | - Yuma Wada
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Kozo Yoshikawa
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Chie Takasu
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Toshihiro Nakao
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Hideya Kashihara
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
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20
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Jia Z, Cao S, Meng C, Liu X, Li Z, Tian Y, Yu J, Sun Y, Xu J, Liu G, Zhang X, Yang H, Zhong H, Wang Q, Zhou Y. Intraoperative performance and outcomes of robotic and laparoscopic total gastrectomy for gastric cancer: A high-volume center retrospective propensity score matching study. Cancer Med 2023; 12:10485-10498. [PMID: 36924361 PMCID: PMC10225175 DOI: 10.1002/cam4.5785] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Studies on robotic total gastrectomy (RTG) are currently limited. This study aimed to compare the intraoperative performance as well as short- and long-term outcomes of RTG and laparoscopic total gastrectomy (LTG). METHODS A total of 969 patients underwent robotic (n = 161) or laparoscopic (n = 636) total gastrectomy between October 2014 and October 2021. The two groups of patients were matched 1:3 using the propensity score matching (PSM) method. The intraoperative performance as well as short- and long-term outcomes of the robotic (n = 147) and the laparoscopic (n = 371) groups were compared. RESULTS After matching, the estimated intraoperative blood loss was lower (80.51 ± 68.77 vs. 89.89 ± 66.12, p = 0.008), and the total number of lymph node dissections was higher (34.74 ± 12.44 vs. 29.83 ± 12.22, p < 0.001) in the RTG group compared with the LTG group. More lymph node dissections at the upper edge of the pancreas were performed in the RTG group than in the LTG (12.59 ± 4.18 vs. 10.33 ± 4.58, p = 0.001). Additionally, postoperative recovery indicators and laboratory data were greater in the RTG group than those in the LTG group, while postoperative complications were comparable between the two groups (19.0% vs. 18.9%, p = 0.962). For overweight or obese patients with body mass indexes (BMIs) ≥25, certain clinical outcomes of the RTG remained advantageous, and no significant differences in three-year overall survival (OS) or relapse-free survival (RFS) were observed. CONCLUSIONS Robotic total gastrectomy demonstrated better intraoperative performance, could improve the short-term clinical outcomes of patients, and was more conducive to patient recovery. However, the long-term efficacies of the two approaches were similar. Robotic surgical systems may reduce surgical stress responses in patients, allowing them to receive postoperative chemotherapy sooner.
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Affiliation(s)
- Zhuoyu Jia
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Shougen Cao
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Cheng Meng
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Xiaodong Liu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Zequn Li
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yulong Tian
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Junjian Yu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yuqi Sun
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Jianfei Xu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Gan Liu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Xingqi Zhang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Hao Yang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Hao Zhong
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Qingrui Wang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yanbing Zhou
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
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21
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Song Y, Zhang Q, Feng Z, Wang B, Ren S. The comparison of short-term outcomes between robotic and laparoscopic radical distal gastrectomy. Langenbecks Arch Surg 2023; 408:131. [PMID: 36991272 PMCID: PMC10060261 DOI: 10.1007/s00423-023-02866-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE The study's objectives were to compare the short-term outcomes of robotic radical distal gastrectomy (RDG) with laparoscopic radical distal gastrectomy (LDG) for patients with gastric cancer and investigate the learning curve of RDG. METHODS The cumulative sum (CUSUM) method was used to retrospectively analyze consecutive gastric cancer patients undergoing RDG between January 2019 and October 2021. The duration of surgery, clinical-pathological characteristics, and short-term outcomes were evaluated according to the two phases of the learning curve (learning period versus mastery period). We also compared the clinical-pathological characteristics and short-term outcomes between cases in the mastery period and LDG. RESULTS Data from 290 patients were included in this analysis, 135 RDG and 155 LDG cases. The learning period was 20 cases. There were no significant differences in clinical-pathological characteristics between the learning period and mastery period. Compared with the learning period, the mastery period had a significant reduction in total operation time, docking time, pure operation time, and estimated blood loss, and a significant increase in hospital costs (P=0.000, 0.000, 0.000, 0.003, and 0.026, respectively). Compared with LDG, robotic cases in mastery period had a longer operative time, shorter first postoperative flatus time, and more hospital costs (P=0.000, 0.005, and 0.000, respectively). CONCLUSIONS RGD may fasten to recover gastrointestinal function faster after the operation, can be mastered easily after a reasonable number of cases, and was associated with safe and satisfactory short-term outcomes before and after the learning curve.
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Affiliation(s)
- Yang Song
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Qianshi Zhang
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Zhen Feng
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Bo Wang
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China.
| | - Shuangyi Ren
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China.
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22
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Comparison of Short-Term Surgical Outcomes of Two Types of Robotic Gastrectomy for Gastric Cancer: Ultrasonic Shears Method Versus the Maryland Bipolar Forceps Method. J Gastrointest Surg 2023; 27:222-232. [PMID: 36376726 DOI: 10.1007/s11605-022-05527-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study investigated the impact and short-term surgical outcomes of two different main energy devices for robotic gastrectomy for gastric cancer. The outcomes of robotic gastrectomy with ultrasonic shears and those of robotic gastrectomy with conventional forceps were compared. METHODS We retrospectively evaluated 171 patients who underwent robotic distal gastrectomy or total gastrectomy for gastric cancer. We classified patients into the ultrasonic shears (US) and Maryland bipolar (MB) forceps groups according to the main energy device used for robotic gastrectomy. RESULTS We extracted 58 patients from the US group and 58 patients from the MB forceps groups using propensity score matching. The total console time (310 min [interquartile range (IQR), 253-369 min] and 332 min, [IQR, 294-429 min]; p = 0.022) and the console time to gastrectomy (222 min [IQR, 177-266 min] and 247 min [IQR, 208-321 min]; p = 0.004) were significantly shorter in the US group than in the MB forceps group. Less blood loss occurred in the US group than in the MB forceps group (20 mL [IQR, 10-40 mL] and 30 mL [IQR, 16-80 mL]; p = 0.014). The postoperative complication rate and postoperative hospital stay length were similar between groups. A multivariate multiple linear regression analysis demonstrated that the use of an ultrasonically activated device was one an independent factor that reduced the operative time of robotic gastrectomy. CONCLUSION Using ultrasonic shears as the main energy device may contribute to better surgical outcomes after robotic gastrectomy for gastric cancer.
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23
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Fu J, Li Y, Liu X, Jiao X, Qu H, Wang Y, Niu Z. Effects of robotic and laparoscopic-assisted surgery on lymph node dissection and quality of life in the upper third of gastric cancer: A retrospective cohort study based on propensity score matching. Front Surg 2023; 9:1057496. [PMID: 36684301 PMCID: PMC9845627 DOI: 10.3389/fsurg.2022.1057496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Objective The objective of this study was compare the effects of robot-assisted and laparoscopic-assisted surgery on lymph node dissection and quality of life in upper third gastric cancer patients undergoing radical total gastrectomy. Methods The clinical and follow-up data of 409 patients with upper third gastric cancer who underwent total gastrectomy from July 2016 to May 2021 were enrolled. The patients were divided into a robotic group (n = 106) and a laparoscopic group (n = 303). Age, sex, body mass index, American Society of Anesthesiologists score, tumor size and location, pathological type, cT, cN, and cTNM were adjusted to offset selection bias. The patient characteristics, operative procedures, surgical outcomes, oncologic and pathologic outcomes, number of lymph node dissections, quality of life assessment, and nutritional status were compared between the two groups. Results After propensity score matching, 61 cases were included in the robotic group and 122 cases were included in the laparoscopic group. The number of dissected lymph nodes (37.3 ± 13.5 vs. 32.8 ± 11.8, P = 0.022) significantly differed between the two groups. The number of lower mediastinal and subphrenic lymph nodes in the robotic group was greater than that in the laparoscopic group, and the difference was statistically significant (P < 0.001). Compared with the laparoscopic group, the total score of physical symptoms in the robotic group was significantly lower at 6 and 12 months after surgery (P = 0.03 and P = 0.001, respectively). The total social function score at 6 and 12 months after surgery was higher in the robotic group (P = 0.006 and P = 0.022). The quality of life scores were statistically significant only at 3 months after the operation (P = 0.047). A higher patient-generated subjective global assessment (PG-SGA) score is when the score significantly correlated (P < 0.001) with a higher related physical symptoms score, lower social function score, and lower quality of life score. Conclusion Compared with laparoscopic radical gastrectomy, robotic radical gastrectomy is safe and feasible. Compared with laparoscopic radical gastrectomy, robotic radical gastrectomy was more refined, was associated with less surgical bleeding, and increased the quality of lymph node dissection. In addition, patients in the robotic group showed better postoperative quality of life.
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24
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Park SH, Kim KY, Kim YM, Hyung WJ. Patient-specific virtual three-dimensional surgical navigation for gastric cancer surgery: A prospective study for preoperative planning and intraoperative guidance. Front Oncol 2023; 13:1140175. [PMID: 36895483 PMCID: PMC9989470 DOI: 10.3389/fonc.2023.1140175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 02/23/2023] Open
Abstract
Introduction Abdominal computed tomography (CT) can accurately demonstrate organs and vascular structures around the stomach, and its potential role for image guidance is becoming increasingly established. However, solely using two-dimensional CT images to identify critical anatomical structures is undeniably challenging and not surgeon-friendly. To validate the feasibility of a patient-specific 3-D surgical navigation system for preoperative planning and intraoperative guidance during robotic gastric cancer surgery. Materials and methods A prospective single-arm open-label observational study was conducted. Thirty participants underwent robotic distal gastrectomy for gastric cancer using a virtual surgical navigation system that provides patient-specific 3-D anatomical information with a pneumoperitoneum model using preoperative CT-angiography. Turnaround time and the accuracy of detecting vascular anatomy with its variations were measured, and perioperative outcomes were compared with a control group after propensity-score matching during the same study period. Results Among 36 registered patients, 6 were excluded from the study. Patient-specific 3-D anatomy reconstruction was successfully implemented without any problems in all 30 patients using preoperative CT. All vessels encountered during gastric cancer surgery were successfully reconstructed, and all vascular origins and variations were identical to operative findings. The operative data and short-term outcomes between the experimental and control group were comparable. The experimental group showed shorter anesthesia time (218.6 min vs. 230.3 min; P=0.299), operative time (177.1 min vs. 193.9 min; P=0.137), and console time (129.3 min vs. 147.4 min; P=0.101) than the control group, although the differences were not statistically significant. Conclusions Patient-specific 3-D surgical navigation system for robotic gastrectomy for gastric cancer is clinically feasible and applicable with an acceptable turnaround time. This system enables patient-specific preoperative planning and intraoperative navigation by visualizing all the anatomy required for gastrectomy in 3-D models without any error. Clinical trial registration Clinicaltrials.gov, identifier NCT05039333.
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Affiliation(s)
- Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.,Vision AI, Hutom, Seoul, Republic of Korea
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25
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Li ZY, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Hu JK, Qian F, Shi Y, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yang K, Wen Y, Zhao YL, Yu PW. Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Cohort Study of 5402 Patients in China. Ann Surg 2023; 277:e87-e95. [PMID: 34225299 DOI: 10.1097/sla.0000000000005046] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A large-scale multicenter retrospective cohort study was conducted to compare the short- and long-term outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. SUMMARY OF BACKGROUND DATA RG is being increasingly used worldwide, but data from large-scale multicenter studies on the short- and long-term oncologic outcomes of RG versus LG are limited. The potential benefits of RG compared with LG for gastric cancer remain controversial. METHODS Data from eligible patients who underwent RG or LG for gastric cancer of 11 experienced surgeons from 7 centers in China between March 2010 and October 2019 were collected. The RG group was matched 1:1 with the LG group by using propensity score matching. The primary outcome was postoperative complications. RESULTS After propensity score matching, a well-balanced cohort of 3552 patients was included for further analysis. The occurrence of overall complications (12.6% vs 15.2%, P = 0.023) was lower in the RG group than in the LG group. RG was associated with less blood loss (126.8 vs 142.5 mL, P < 0.001) and more retrieved lymph nodes in total (32.5 vs 30.7, P < 0.001) and in suprapancreatic areas (13.3 vs 11.6, P < 0.001).The long-term oncological outcomes were comparable between the two groups. CONCLUSIONS The results of this multicenter study demonstrate that RG is a safe and effective treatment for gastric cancer when performed by experienced surgeons, although longer operation time and higher costs are still concerns about RG. This study provides evidence suggesting that RG may represent an alternative surgical treatment to LG.
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Affiliation(s)
- Zheng-Yan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yan-Bing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tai-Yuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ji-Peng Li
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhi-Wei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun-Jun She
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Qian
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yu-Long Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Geng-Mei Gao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui-Zi Gao
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Cai Liang
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fei-Yu Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kun Yang
- Department of Gastrointestinal Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Wen
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Pei-Wu Yu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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26
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Kostov G, Dimov R, Doykov M. Comparison of short term results following robotic and laparoscopic total gastrectomy and D2 lymph node dissection. Folia Med (Plovdiv) 2022; 64:889-895. [PMID: 36876567 DOI: 10.3897/folmed.64.e89545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/10/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION In the last decade, there has been a progressive shift from open to mini-invasive operative techniques for surgical resection of gastric cancer. Advanced equipment of surgical robots, with its 3D visualization, steady camera view, flexible instrument tips, attracts more and more practitioners in performing robotic gastrectomy with D2 dissection in gastric cancer patients. Thus, the comparison of some basic oncological as well as some surgical variables related to laparoscopic and robotic gastrectomy and D2 lymphadenectomy is necessary.
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Affiliation(s)
| | - Rossen Dimov
- Medical University of Plovdiv, Plovdiv, Bulgaria
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27
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Chen QY, Zhong Q, Liu ZY, Li P, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Lin GT, Zheng CH, Huang CM, Xie JW. Surgical Outcomes, Technical Performance, and Surgery Burden of Robotic Total Gastrectomy for Locally Advanced Gastric Cancer: A Prospective Study. Ann Surg 2022; 276:e434-e443. [PMID: 33491975 DOI: 10.1097/sla.0000000000004764] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the short-term outcomes, surgery burden, and technical performance of robotic total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) for gastric cancer (GC). SUMMARY OF BACKGROUND DATA The impact of robotic systems on total gastrectomy remains obscure. METHODS This prospective study included 50 patients with advanced proximal GC underwent RTG combined with spleen-preserving splenic hilar lymphadenectomy between March 2018 and February 2020. Patients who underwent LTG in the FUGES-002, http://links.lww.com/SLA/C929 study were enrolled to compare the outcomes between RTG and LTG. RESULTS After propensity score matching, 48 patients in the RTG group and 96 patients in the LTG group were included in the analysis. The RTG group had a lower volume of intraoperative blood loss than the LTG group (38.7 vs 66.4 mL, P = 0.042). Significantly more extraperigastric lymph nodes were retrieved in the RTG group than in the LTG group (20.2 vs 17.5, P = 0.039). The average number of errors was lower in the RTG group than in the LTG group (43.2 vs 53.8 times/case, P < 0.001). The RTG group had a higher technical skill score (30.2 vs 28.4, P < 0.001) and a lower surgery task load index (33.2 vs 39.8, P < 0.001) than the LTG group. No significant difference was found in terms of postoperative morbidity between the 2 groups (14.6% vs 16.7%, P = 0.748). CONCLUSIONS In complex total gastrectomy for GC, compared with traditional laparoscopic surgery, robotic surgery provides a technically superior operative environment and reduces surgeon workload at high-volume specialized institutions.
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Affiliation(s)
- Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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Fluorescent Lymphography-Guided Lymphadenectomy during Minimally Invasive Completion Total Gastrectomy for Remnant Gastric Cancer Patients. Cancers (Basel) 2022; 14:cancers14205037. [PMID: 36291822 PMCID: PMC9600016 DOI: 10.3390/cancers14205037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary The altered lymphatic anatomy around the remnant stomach after initial surgery causes technical difficulties in systematic lymphadenectomy during the completion total gastrectomy. A fluorescent lymphography with indocyanine green under near-infrared imaging is a reliable intraoperative technique for lymphatic identification in minimally invasive gastric cancer surgery. This study aimed to assess the clinical application of fluorescent lymphography in minimally invasive completion total gastrectomy for remnant gastric cancer. More lymph node retrieval was demonstrated in minimally invasive completion total gastrectomy with fluorescent lymphography than without fluorescent lymphography. Fluorescent lymphography is an effective tool for the intraoperative assessment of lymphatics around the remnant stomach and systemic lymphadenectomy during minimally invasive completion total gastrectomy. Abstract No study has evaluated fluorescent lymphography for lymphadenectomy in remnant gastric cancer (RGC). This study aimed to assess the clinical application of fluorescent lymphography in minimally invasive completion total gastrectomy for RGC. Patients who had undergone minimally invasive completion total gastrectomy for RGC from 2013 to 2020 were retrospectively reviewed. The perioperative outcomes and long-term prognosis were compared between patients who had undergone minimally invasive completion total gastrectomy with fluorescent lymphography (the FL group) and those without fluorescent lymphography (the non-FL group). The FL group comprised 32 patients, and the non-FL group comprised 36 patients. FL visualized lymphatics in all 32 patients without complications related to the fluorescent injection. The median number [the interquartile range] of LN retrieval was significantly higher in the FL group (17 [9.3–23.5]) than in the non-FL group (12.5 [4–17.8]); p = 0.016). The sensitivity of fluorescent lymphography in detecting metastatic LN stations was 75%, and the negative predictive value was 96.9% in the FL group. The overall relapse-free survivals were comparable between the groups (p = 0.833 and p = 0.524, respectively). FL is an effective tool to perform a more thorough lymphadenectomy during minimally invasive completion total gastrectomy for RGC. Using FL in RGC surgery may improve surgical quality and proper staging.
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29
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Huang W, Liu S, Chen J. Surgical and short-term outcomes in robotic and laparoscopic distal gastrectomy for gastric cancer with enhanced recovery after surgery protocol: A propensity score matching analysis. Front Surg 2022; 9:944395. [PMID: 36277282 PMCID: PMC9583927 DOI: 10.3389/fsurg.2022.944395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the short-term surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) and robot-assisted distal gastrectomy (RADG) for gastric cancer (GC) with enhanced recovery after surgery (ERAS) protocols. METHODS We reviewed the medical records of 202 patients undergoing radical distal gastrectomy; among them, 67 cases were assisted through RADG, while 135 cases were assisted through LADG along with ERAS. We retrospectively collected the medical records in succession from a database (January 2016-March 2019). We adopted propensity score matching to compare surgical and short-term outcomes of both groups. RESULTS After the successful examination of 134 cases, including 67 receiving RADG and 67 undergoing LADG, the operative times were noted as 5.78 ± 0.96 h for the RADG group and 4.47 ± 1.01 h for the LADG group (P < 0.001). The blood loss was noted as 125.52 ± 101.18 ml in the RADG group and 164.93 ± 109.32 ml in the LADG group (P < 0.05). The shorter time to first flatus was 38.82 ± 10.56 h in the RADG group and 42.88 ± 11.25 h in the LADG group (P < 0.05). In contrast, shorter days of postoperative hospital stay were 5.94 ± 1.89 days in the RADG group and 6.64 ± 1.92 days in the LADG group (P < 0.05). Also, the RADG group (84483.03 ± 9487.37) was much more costly than the LADG group (65258.13 ± 8928.33) (P < 0.001). The postoperative overall complication rates, numbers of dissected lymph nodes, visual analogue scale (VAS), and time to start a liquid diet for the RADG group and the LADG group were similar. CONCLUSIONS In this research, we concluded that RADG provides surgical benefits and short-term outcomes compared to LADG for GC with ERAS.
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Affiliation(s)
- Weijia Huang
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Clinical Research Center for Enhanced Recovery after Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Siyu Liu
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Clinical Research Center for Enhanced Recovery after Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqiang Chen
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Clinical Research Center for Enhanced Recovery after Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Yamashita Y, Tatsubayashi T, Okumura K, Sakura Y, Miyamoto T. Robotic radical distal gastrectomy for gastric cancer using the soft coagulation scissors technique. J Robot Surg 2022; 17:605-611. [PMID: 36169804 DOI: 10.1007/s11701-022-01459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
We have developed a novel technique for safe and precise lymph-node dissection during robotic gastrectomy for gastric cancer using monopolar curved scissors with soft coagulation. This technique is called the soft coagulation scissors technique. The technical details of this technique are as follows: a long bipolar grasper in the first arm and monopolar curved scissors in the third arm are primarily used for lymph-node dissection, maximizing the use of the robotic arm articulation. The monopolar curved scissors were energized in the soft coagulation mode of the Valleylab™ FT10 energy platform or in the forced coagulation mode of the ERBE VIO®dV with an effect 1/power limit of 15 W. This limit was confirmed to be equivalent to the soft coagulation mode in preliminary experiments, and a long bipolar grasper applied adequate tension to the surgical site without strongly grasping the tissue or applying traction. The peak temperatures of our devices were more than 100 °C lower than those of the Harmonic ACE and the Maryland bipolar forceps with the forced coagulation mode. Overall, 80 patients with gastric cancer, including 36 (45.0%) with stage III or IV cancers, underwent robotic distal gastrectomy with this technique. The median estimated blood loss was 10 g. There were only four surgical complications (5.0%): two paralytic ileus, one intra-abdominal abscess, and one duodenal stump leakage. Robotic distal gastrectomy for gastric cancer is made possible by the soft coagulation scissors technique, which allows for safe and precise lymph-node dissection.
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Affiliation(s)
- Yoshito Yamashita
- Department of Gastroenterological Surgery, Japanese Red Cross Wakayama Medical Center and Cancer Center, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan.
| | - Taichi Tatsubayashi
- Department of Gastroenterological Surgery, Japanese Red Cross Wakayama Medical Center and Cancer Center, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan
| | - Koichi Okumura
- Department of Gastroenterological Surgery, Japanese Red Cross Wakayama Medical Center and Cancer Center, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan
| | - Yusuke Sakura
- Department of Gastroenterological Surgery, Japanese Red Cross Wakayama Medical Center and Cancer Center, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan
| | - Takumi Miyamoto
- Department of Gastroenterological Surgery, Japanese Red Cross Wakayama Medical Center and Cancer Center, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan
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Li Z, Ai S, Wang F, Tao L, Sun F, Song P, Shen X, Hu Q, Li X, Liu S, Wang M, Guan W. Comparison of short-term outcomes between robotic-assisted and laparoscopic gastrectomy guided by carbon nanoparticle suspension injection in gastric cancer. World J Surg Oncol 2022; 20:282. [PMID: 36058930 PMCID: PMC9442920 DOI: 10.1186/s12957-022-02755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background The clinical application of robotic-assisted gastrectomy remains controversial, especially as clinical studies of this operation navigated by carbon nanoparticle suspension injection (CNSI) have not been conducted. This study aims to assess the perioperative safety and efficacy of CNSI-guided robotic-assisted gastrectomy in patients with gastric cancer by focusing on short-term outcomes. Methods A retrospective analysis of patients who underwent CNSI-guided laparoscopic or robotic-assisted gastrectomy with a pathological diagnosis of gastric cancer was conducted. Data on demographics, surgical management, clinical-pathological results and short-term outcomes were compared among the groups. Results A total of 126 eligible patients were separated into the robotic-assisted gastrectomy (RAG) group (n = 16) and the laparoscopic gastrectomy (LG) group (n = 110) in total. The operation time of the RAG group is longer than the LG group (p = 0.0000). When it comes to perioperative and short-term complications, there exists no statistical difference between the two groups. Conclusion The time required for CNSI-guided robotic-assisted gastrectomy is longer than that for CNSI-guided laparoscopic gastrectomy. CNSI-guided robotic-assisted gastrectomy is safe and effective.
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Affiliation(s)
- Zhiyan Li
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Shichao Ai
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Feng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Liang Tao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Feng Sun
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Peng Song
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Xiaofei Shen
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Qiongyuan Hu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Xianghui Li
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China
| | - Song Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China.
| | - Meng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China.
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing, 210008, China.
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Jeong SA, Lee IS. Current status of robotic gastrectomy for gastric cancer: A review of recent randomized controlled trials. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seong-A Jeong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Seob Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Nishi M, Shimada M, Yoshikawa K, Takasu C, Wada Y, Tokunaga T, Nakao T, Kashihara H, Yoshimoto T, Yamashita S. Propensity Score-Matched Analysis of the Short- and Long-Term Outcomes of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer. Ann Surg Oncol 2022; 29:3887-3895. [DOI: 10.1245/s10434-021-11203-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022]
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Park SH, Kim JM, Park SS. Current Status and Trends of Minimally Invasive Gastrectomy in Korea. Medicina (B Aires) 2021; 57:medicina57111195. [PMID: 34833413 PMCID: PMC8621245 DOI: 10.3390/medicina57111195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Since its introduction in the early 1990s, laparoscopic gastrectomy has been widely accepted for the treatment of gastric cancer worldwide. In the last decade, the Korean Laparoendoscopic Gastrointestinal Surgery Study group performed important clinical trials and exerted various efforts to enhance the quality of scientific knowledge and surgical techniques in the field of gastric cancer surgery. Laparoscopic gastrectomy has shifted to a new era in Korea due to recent advances and innovations in technology. Here, we discuss the recent updates of laparoscopic gastrectomy—namely, reduced-port, single-incision, robotic, image-guided, and oncometabolic surgery.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
| | - Jong-Min Kim
- Department of Surgery, Min General Surgery Hospital, 155 Dobong-ro, Gangbuk-gu, Seoul 01171, Korea;
| | - Sung-Soo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
- Correspondence: or ; Tel.: +82-2-920-6772; Fax: +82-2-928-1631
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Shin HJ, Son SY, Wang B, Roh CK, Hur H, Han SU. Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Propensity Score-weighted Analysis of 2084 Consecutive Patients. Ann Surg 2021; 274:128-137. [PMID: 32187032 DOI: 10.1097/sla.0000000000003845] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias. SUMMARY OF BACKGROUND DATA Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG). METHODS Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model. RESULTS After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P = 0.498). CONCLUSIONS After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.
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Affiliation(s)
- Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Department of Transplantation and Vascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Bo Wang
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Chul Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
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Choi S, Son T, Song JH, Lee S, Cho M, Kim YM, Kim HI, Hyung WJ. Intracorporeal Esophagojejunostomy during Reduced-port Totally Robotic Gastrectomy for Proximal Gastric Cancer: a Novel Application of the Single-Site ® Plus 2-port System. J Gastric Cancer 2021; 21:132-141. [PMID: 34234975 PMCID: PMC8255302 DOI: 10.5230/jgc.2021.21.e16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/27/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose Intracorporeal esophagojejunostomy during reduced-port gastrectomy for proximal gastric cancer is a technically challenging technique. No study has yet reported a robotic technique for anastomosis. Therefore, to address this gap, we describe our reduced-port technique and the short-term outcomes of intracorporeal esophagojejunostomy. Materials and Methods We conducted a retrospective review of patients who underwent a totally robotic reduced-port total or proximal gastrectomy between August 2016 and March 2020. We used an infra-umbilical Single-Site® port with two additional ports on both sides of the abdomen. To transect the esophagus, a 45-mm endolinear stapler was inserted via the right abdominal port. The common channel of the esophagojejunostomy was created between the apertures in the esophagus and proximal jejunum using a 45-mm linear stapler. The entry hole was closed with a 45-mm linear stapler or robot-sewn continuous suture. All anastomoses were performed without the aid of an assistant or placement of stay sutures. Results Among the 40 patients, there were no conversions to open, laparoscopic, or conventional 5-port robotic surgery. The median operation time and blood loss were 254 min and 50 mL, respectively. The median number of retrieved lymph nodes was 40.5. The median time to first flatus, soft diet intake, and length of hospital stay were 3, 5, and 7 days, respectively. Three (7.5%) major complications, including two anastomosis-related complications and a case of small bowel obstruction, were treated with an endoscopic procedure and re-operation, respectively. No mortality occurred during the study period. Conclusions Intracorporeal esophagojejunostomy during reduced-port gastrectomy can be safely performed and is feasible with acceptable surgical outcomes.
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Affiliation(s)
- Seohee Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Jeong Ho Song
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sejin Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
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Marano L, D'Ignazio A, Resca L, Marrelli D, Roviello F. Robotic-assisted gastrectomy for gastric cancer: single Western center results. Updates Surg 2021; 73:865-872. [PMID: 33058054 PMCID: PMC8184723 DOI: 10.1007/s13304-020-00896-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
A robotic approach to abdominal surgery procedures may improve postoperative outcomes compared to either open or laparoscopic approaches. The role of robotics for gastric surgery, however, is still being evaluated. A retrospective review of the prospectively maintained database for robotic gastric surgery at University of Siena between 2011 and 2020 was conducted. Data regarding surgical procedures, early postoperative outcomes, and long-term follow-up were analyzed. 38 patients underwent robotic partial or total gastrectomy. Conversion to open occurred in two patients (5.2%) due to locally advanced disease as well as difficult identification of primary lesion. Postoperative morbidity was 13.1% while no postoperative mortality was registered. The mean length of operation was 358.6 (220-650) minutes and the mean number of retrieved lymph nodes was 35.8 (range: 5-73). The median OS of all population was 70.9 months. The median 5-year OS for the patients with positive nodes was worse than that of patients without metastatic lymph nodes [51.4 months (95% CI 35.5-67.4) vs. 79.5 months (95% CI 67.1-91.8); p = 0.079]. The interesting results including postoperative morbidity as well as mortality rate, the surgical outcomes, and the 5-year OS, were to be acceptable considering the data recorded by previous studies on robotic gastrectomy. This study demonstrated that robotic gastrectomy is feasible and can be safely performed. However, further follow-up and randomized clinical trials are required to confirm the role of a robotic approach in gastric cancer surgery.
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Affiliation(s)
- Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Strada Delle Scotte, 4, 53100, Siena, Italy.
| | - Alessia D'Ignazio
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Strada Delle Scotte, 4, 53100, Siena, Italy
| | - Luca Resca
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Strada Delle Scotte, 4, 53100, Siena, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Strada Delle Scotte, 4, 53100, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Strada Delle Scotte, 4, 53100, Siena, Italy
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Comprehensive Learning Curve of Robotic Surgery: Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy. Ann Surg 2021; 273:949-956. [PMID: 31503017 DOI: 10.1097/sla.0000000000003583] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the complication-based learning curve and identify learning-associated complications of robotic gastrectomy. SUMMARY BACKGROUND DATA With the increased popularity of robotic surgery, a sound understanding of the learning curve in the surgical outcome of robotic surgery has taken on great importance. However, a multicenter prospective study analyzing learning-associated morbidity has never been conducted in robotic gastrectomy. METHODS Data on 502 robotic gastrectomy cases were prospectively collected from 5 surgeons. Risk-adjusted cumulative sum analysis was applied to visualize the learning curve of robotic gastrectomy on operation time and complications. RESULTS Twenty-five cases, on average, were needed to overcome complications and operation time-learning curve sufficiently to gain proficiency in 3 surgeons. An additional 23 cases were needed to cross the transitional phase to progress from proficiency to mastery. The moderate complication rate (CD ≥ grade II) was 20% in phase 1 (cases 1-25), 10% in phase 2 (cases 26-65), 26.1% in phase 3 (cases 66-88), and 6.4% in phase 4 (cases 89-125) (P < 0.001). Among diverse complications, CD ≥ grade II intra-abdominal bleeding (P < 0.001) and abdominal pain (P = 0.01) were identified as major learning-associated morbidities of robotic gastrectomy. Previous experience on laparoscopic surgery and mode of training influenced progression in the learning curve. CONCLUSIONS This is the first study suggesting that technical immaturity substantially affects the surgical outcomes of robotic gastrectomy and that robotic gastrectomy is a complex procedure with a significant learning curve that has implications for physician training and credentialing.
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Lu J, Zheng CH, Xu BB, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Huang CM, Li P. Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. Ann Surg 2021; 273:858-867. [PMID: 32889876 DOI: 10.1097/sla.0000000000004466] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the short-term outcomes of patients with GC who received RDG or LDG. SUMMARY BACKGROUND DATA Despite the increasing use of RDG in patients with GC, its safety and efficacy compared to those of LDG have not been elucidated in a randomized controlled trial. METHODS Three hundred patients with cT1-4a and N0/+ between September 2017 and January 2020 were enrolled in this randomized controlled trial at a high-volume hospital in China. The short-term outcomes were compared between the groups. RESULTS The modified intention-to-treat analysis included data from 283 patients (RDG group: n = 141) and (LDG group: n = 142). Patients in the RDG group exhibited faster postoperative recovery, milder inflammatory responses, and reduced postoperative morbidity (9.2% vs 17.6%, respectively, P = 0.039). Higher extraperigastric lymph nodes (LNs) were retrieved in the RDG group (17.6 ± 5.8 vs 15.8 ± 6.6, P = 0.018) with lower noncompliance rate (7.7% vs 16.9%, respectively, P = 0.006). Additionally, patients in the RDG group were more likely to initiate adjuvant chemotherapy earlier [median (interquartile range) postoperative days: 28 (24-32) vs 32 (26-42), P = 0.003]. Although total hospital costs were higher in the robotic group than in the laparoscopic group, the direct cost was lower for RDG than for LDG (all P < 0.001). CONCLUSIONS RDG is associated with a lower morbidity rate, faster recovery, milder inflammatory responses, and improved lymphadenectomy. Additionally, faster postoperative recovery in the RDG group enables early initiation of adjuvant chemotherapy. Our results provide evidence for the application of RDG in patients with GC.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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Solaini L, D'Ignazio A, Marrelli D, Marano L, Avanzolini A, Morgagni P, Roviello F, Ercolani G. The effect of learning curve on perioperative outcomes of robotic gastrectomy in two western high-volume centers. Int J Med Robot 2021; 17:e2212. [PMID: 33340239 DOI: 10.1002/rcs.2212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/09/2020] [Accepted: 12/16/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION To compare outcomes of robotic gastrectomy (RG) performed during the learning curve (P1) with those after its completion (P2). METHODS In this retrospective study, all consecutive RG patients (n = 92) performed between 2008 and 2018 were included. Primary outcome was conversion rate. RESULTS D2 lymphadenectomies were more common in P2 (41, 97.6%) than P1 (41, 82.0%) (p = 0.019). Conversions were 11 (22%) in P1 versus 2 (4.8%) in P2 (p = 0.006). Postoperative morbidity was comparable between the groups. Median hospital stay was significantly shorter in P2. The only factor significantly associated with conversion was P2 (odds ratio = 0.18; 95% confidence interval, 0.04-0.85; p = 0.039). The 5-year overall survival in P1 was 79.6% versus 79.7% in P2 (p = 0.373). CONCLUSIONS The learning curve affected operative and postoperative outcomes: during the learning curve, conversion to open surgery was significantly more frequent, the number of D2 was higher and patients were discharged earlier.
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Affiliation(s)
- Leonardo Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessia D'Ignazio
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Andrea Avanzolini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Paolo Morgagni
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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41
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Tian Y, Cao S, Kong Y, Shen S, Niu Z, Zhang J, Chen D, Jiang H, Lv L, Liu X, Li Z, Zhong H, Zhou Y. Short- and long-term comparison of robotic and laparoscopic gastrectomy for gastric cancer by the same surgical team: a propensity score matching analysis. Surg Endosc 2021; 36:185-195. [PMID: 33427913 DOI: 10.1007/s00464-020-08253-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research on short-term outcomes and oncology results after robotic gastrectomy (RG) is still limited, especially from a single surgical team. The purpose of this study was to compare the short-term and long-term outcomes of robotic and laparoscopic gastrectomy (LG). METHODS Between October 2014 and September 2019, 1686 consecutive patients who underwent MIS gastrectomy were enrolled. The patients were divided into RG and LG groups according to surgical type. Groups were matched at a 1:1 ratio using propensity scores based on the following variables: age, sex, ASA score, primary tumor location, histologic type, pathological stage, and neoadjuvant chemotherapy. The primary outcomes were 3-year overall survival (OS) and relapse-free survival (RFS). The secondary outcomes were postoperative short-term outcomes. RESULTS Demographic and baseline characteristics were similar between the two groups after matching. Compared to the LG group, the RG group had a significantly higher retrieved lymph node (LN) number (32.15 vs 30.82, P = 0.040), more retrieved supra-pancreatic LNs (12.45 vs 11.61, P = 0.028), lower estimated blood loss (73.67 vs 98.08 ml, P < 0.001), but longer operation time (205.18 vs 185.27 min, P < 0.001) and higher hospitalization costs ($13,607 vs $10,928, P < 0.001) in the matched cohort. In the subgroup analysis, we observed that compared with LG, patients with advanced gastric cancer benefitted more from RG surgery. The matched cohort analysis demonstrated no statistically significant differences for 3-year OS or RFS (log-rank, P = 0.648 and P = 0.951, respectively): 80.3% and 77.0% in LG vs. 81.2% and 76.6% in RG, respectively. CONCLUSION RG has certain technical advantages over LG, especially in patients with advanced gastric cancer. However, RG does not improve long-term oncology outcomes.
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Affiliation(s)
- Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Ying Kong
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China.,Department of Gastrointestinal Surgery, Jining No. 1 People's Hospital, No. 6 Jiankang Road, Central District, Jining City, 272013, Shandong Province, China
| | - Shuai Shen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Zhaojian Niu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Jian Zhang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Dong Chen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Haitao Jiang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Liang Lv
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Hao Zhong
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Shinan District, Qingdao, 266003, China.
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Li ZY, Zhao YL, Qian F, Tang B, Chen J, He T, Luo ZY, Li PA, Shi Y, Yu PW. Long-term oncologic outcomes of robotic versus laparoscopic gastrectomy for locally advanced gastric cancer: a propensity score-matched analysis of 1170 patients. Surg Endosc 2021; 35:6903-6912. [PMID: 33398578 DOI: 10.1007/s00464-020-08198-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The robotic surgical system has several technical advantages over laparoscopic instruments. The technical feasibility and safety of robotic gastrectomy (RG) for gastric cancer have been reported by increasing number of studies. However, the long-term survival and recurrence outcomes after RG for locally advanced gastric cancer (AGC) have seldom been reported. This study aimed to compare long-term oncologic outcomes for patients with locally AGC after RG or laparoscopic gastrectomy (LG). METHODS This study comprised 1170 patients underwent RG or LG, respectively, for locally AGC between March 2010 and February 2017. The primary outcome was the 3-year disease-free survival (DFS). The secondary endpoint included 3-year overall survival (OS) and recurrence patterns. One-to-one propensity score matching (PSM) was performed to reduce confounding bias. The outcomes were compared in PSM cohort. RESULTS After PSM, a well-balanced cohort of 816 patients (408 in each group) were included in the analysis. The 3-year DFS rate was 76.2% in the robotic group and 70.1% in the laparoscopic group (P = 0.076). The 3-year OS rates was 76.7% in the robotic group and 73.3% in the laparoscopic group (P = 0.246). In the subgroup analyses for potential confounding variables, neither 3-year DFS nor 3-year OS survival were significantly different between the two groups (all P > 0.05). The two groups showed similar recurrence patterns within 3 years after surgery (P > 0.05). CONCLUSION For patients with locally AGC, RG can result in comparable long-term survival outcomes without an increase in recurrence rate.
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Affiliation(s)
- Zheng-Yan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Yong-Liang Zhao
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Feng Qian
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Bo Tang
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Jun Chen
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Tao He
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Zi-Yan Luo
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Ping-Ang Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Yan Shi
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China.
| | - Pei-Wu Yu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No.30 Gao Tan Yan Road, Chongqing, 400038, China.
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Kim YM, Hyung WJ. Current status of robotic gastrectomy for gastric cancer: comparison with laparoscopic gastrectomy. Updates Surg 2021; 73:853-863. [PMID: 33394356 DOI: 10.1007/s13304-020-00958-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/24/2022]
Abstract
Robotic systems were developed to overcome limitations of laparoscopic surgery with its mechanical advantages. Along with the technical advances, robotic gastrectomy for gastric cancer is increasing. However, the evidence regarding safety and efficacy for robotic gastrectomy for gastric cancer is not mature yet. Although studies are limited, it is evident that robotic gastrectomy has a longer operation and less blood loss compared with laparoscopic gastrectomy. Studies revealed long-term oncological outcomes after robotic gastrectomy was comparable to those after laparoscopic gastrectomy. Taken together, robotic gastrectomy with systemic lymph node dissection is suggested as a safe procedure with equivalent short- and long-term oncologic outcomes to either laparoscopic or open gastrectomy for the surgical treatment of gastric cancer. However, high cost is the most significant barrier to justify robotic surgery as a routine and standard treatment for patients with gastric cancer. In the meanwhile, robotic surgery will be expansively used as long as technologic developments continue.
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Affiliation(s)
- Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
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Ambrosini F, Caracino V, Frazzini D, Coletta P, Liberatore E, Basti M. Robot-assisted laparoscopic subtotal gastrectomy for early-stage gastric cancer: Case series of initial experience. Ann Med Surg (Lond) 2021; 61:115-121. [PMID: 33437473 PMCID: PMC7785990 DOI: 10.1016/j.amsu.2020.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the last decade's robotic gastrectomy (RG) has increasingly widespread as a valid minimally invasive option for treatment of gastric cancer. In literature, evidence of its routine use is not yet well established. The aims of this study are to report our initial experience and to present possible advantages of our hybrid operative technique for subtotal gastrectomy. MATERIALS AND METHODS Retrospectively, we analyzed data from 41 patients (22 male and 19 female) who underwent robot-assisted laparoscopic subtotal gastrectomy (RALG) with D2 lymphadenectomy using the da Vinci XI robotic system. Inclusion criteria were gastric cancer in the middle or lower portion of the stomach amenable of radical subtotal gastrectomy without preoperative suspicion of positive lymph-nodes or other organs involving and distant metastasis. All the procedures were performed by attending surgeons. RESULTS The mean operative time was 270 min with one case of conversion to open surgery. The mean age was 71.4 (IQR 68.2-76.8) with 43.9% of patients classified as ASA (American Society of Anesthesiologists) score ≥3. The median of lymph-nodes retrieved was 25 (IQR 19-35). No intra-operative complications occurred. Time to resume a soft diet was 5 days. Patients were hospitalized a median of 7 days. According to pathological AJCC-TNM, 21 patients were classified as advanced gastric cancer. Post-operative morbidity was recorded in 9 patients (21.9%) with major complications requiring surgical operation in 4 patients (9.8%). Elevated ASA score, fewer lymph-nodes retrieved and ICU recovery requirements were significant increased in patients with major complications. CONCLUSION The preliminary results demonstrated that robot-assisted laparoscopic subtotal gastrectomy is safe and feasible. In particular, we found that the da Vinci platform improves surgeon abilities to perform an adequate lymphadenectomy and digestive reconstruction. Further studies are necessary to better clarify the role of this high-cost technology in minimally invasive treatment of gastric cancer.
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Affiliation(s)
- Fabio Ambrosini
- Department of General and Emergency Surgery, St Spirito's Hospital of Pescara, 65124, Pescara, Italy
| | - Valerio Caracino
- Department of General and Emergency Surgery, St Spirito's Hospital of Pescara, 65124, Pescara, Italy
| | - Diletta Frazzini
- Department of General and Emergency Surgery, St Spirito's Hospital of Pescara, 65124, Pescara, Italy
| | - Pietro Coletta
- Department of General and Emergency Surgery, AOU Ospedali Riuniti of Ancona, 60020, Ancona, Italy
| | - Edoardo Liberatore
- Department of General Surgery, St Liberatore's Hospital of Atri, 64032, Teramo, Italy
| | - Massimo Basti
- Department of General and Emergency Surgery, St Spirito's Hospital of Pescara, 65124, Pescara, Italy
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Solaini L, Avanzolini A, Pacilio CA, Cucchetti A, Cavaliere D, Ercolani G. Robotic surgery for gastric cancer in the west: A systematic review and meta-analyses of short-and long-term outcomes. Int J Surg 2020; 83:170-175. [PMID: 32942065 DOI: 10.1016/j.ijsu.2020.08.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND This review aims to merge all the western studies dealing with robotic gastrectomies (RG) to provide pooled results and higher levels of evidence supporting the use of robotic gastrectomy for the treatment of gastric cancer also at western latitudes. METHODS A systematic literature search was performed in PubMed, Embase, and Scopus for studies published between 2010 and 2020 concerning RG in western centers. Case series and comparative studies (robotic versus open and robotic versus laparoscopic) were included. RESULTS After screening 1732 articles, 10 articles with a total of 988 patients undergoing RG in western centers were eligible for inclusion. Included studies showed a relatively low risk of bias. The pooled conversion rate was 3.9% (95% CI 1.2-7.9). The pooled overall complications rate was 15% (7.1-25.3) with a mortality rate of 2.5% (1.1-4.7). The pooled 5-year overall survival rate was 60.4% (46.0-74.1). The pooled analyses of the comparative studies (robotic versus open) included 132 robotic and 305 open gastrectomies and showed comparable safety parameters. The robotic group had a pooled 5-year overall survival of 55.2% (33.7-75.8) versus 50.8% (36.4-65.2) of the open group (RR 1.10, 0.78-1.55; p = 0.248 - I2 51.8, 0.0-86.1; p = 0.125). The meta analyses of the results from the studies comparing the robotic (n = 679) and the laparoscopic (n = 1355) approach (LG) showed similar morbidity (RG 19.9%, 10.2-32.0 versus LG 15.6%, 8.7-24.0; p = 0.706) and mortality rates (RG 5.5%, 3.9-7.3 versus LG 4.3%, 3.3-5.4; p = 0.272). RG had longer operative time (RG 327 min, 297-358 versus LG 248, 222-275; p = 0.001) and lower blood loss (RG 99 ml, 96-103 versus LG 133, 104-161; p < 0.001) than laparoscopic gastrectomy. CONCLUSION Based on the available data from western centers, robotic gastrectomy is comparable with the open and the laparoscopic approaches with regards to short term outcomes. Survival data of RG were similar to open gastrectomies, but studies on long-term outcomes are required to confirm these results.
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Affiliation(s)
- Leonardo Solaini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy; General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy.
| | - Andrea Avanzolini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy; General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Davide Cavaliere
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy; General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
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Kim JS, Batajoo H, Son T, Choi S, Seo WJ, Cho M, Kim YM, Lee JH, Kim HI, Hyung WJ. Delta-shaped gastroduodenostomy using a robotic stapler in reduced-port totally robotic gastrectomy: its safety and efficiency compared with conventional anastomosis techniques. Sci Rep 2020; 10:14729. [PMID: 32895470 PMCID: PMC7477196 DOI: 10.1038/s41598-020-71807-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/21/2020] [Indexed: 01/01/2023] Open
Abstract
To investigate the safety and efficiency of using robotic staplers for intracorporeal gastroduodenostomy in reduced-port robotic gastrectomy for gastric adenocarcinoma. We retrospectively reviewed patients who underwent totally robotic and laparoscopic gastrectomy with intracorporeal gastroduodenostomy. Gastroduodenostomy using the ENDOWRIST robotic stapler (RR) was compared to that using an endolinear stapler during robotic gastrectomy (RE) and to that using an endolinear stapler during laparoscopic gastrectomy (LE). A total of 296 patients underwent gastroduodenostomy: 58, 28, and 210 patients with RR, RE, and LE, respectively. There were no conversions to other methods, and all robotic stapling procedures were performed on the console without receiving additional assistance from a bedside surgeon during RR. Comparing the operative outcomes of RR with those of RE and LE, respectively, we noted similar postoperative short-term outcomes. There were no major complications, including anastomosis-related complications, during the postoperative period after RR. The median reconstruction time during RR was 8 min and 45 s, which was similar to that during RE (8 min, 5 s [P > 0.9999]), but longer than that during LE (6 min, 30 s [P < 0.0001]). Intracorporeal gastroduodenostomy using the robotic stapler during robotic gastrectomy could be safely and feasibly performed on the console without the assistance of assistant, bedside surgeons.
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Affiliation(s)
- Ji Su Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hemant Batajoo
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Surgery, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Gastric Cancer Center, Yonsei Cancer Hospital, Yonsei University Health System, Seoul, Republic of Korea.
| | - Seohee Choi
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Won Jun Seo
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Joong Ho Lee
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeongi, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Yonsei University Health System, Seoul, Republic of Korea
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47
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Guerrini GP, Esposito G, Magistri P, Serra V, Guidetti C, Olivieri T, Catellani B, Assirati G, Ballarin R, Di Sandro S, Di Benedetto F. Robotic versus laparoscopic gastrectomy for gastric cancer: The largest meta-analysis. Int J Surg 2020; 82:210-228. [PMID: 32800976 DOI: 10.1016/j.ijsu.2020.07.053] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) has been increasingly used in the treatment of gastric cancer (GC). Laparoscopic gastrectomy (LG) has shown several advantages over open surgery in dealing with GC, although it is still considered a demanding procedure. Robotic gastrectomy (RG) is now being employed with increased frequency worldwide and has been reported to overcome some limitations of conventional LG. The aim of this updated meta-analysis is to compare surgical and oncological outcomes of RG versus LG for gastric cancer. MATERIALS AND METHODS A systematic review and meta-analysis was conducted using the PubMed, MEDLINE and Cochrane library database of published studies comparing RG and LG up to March 2020. The evaluated end-points were intra-operative, post-operative and oncological outcomes. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (95% CI), and a random-effect model was always applied. RESULTS Forty retrospective studies describing 17,712 patients met the inclusion criteria. With respect to surgical outcomes, robotic compared with laparoscopic gastrectomy was associated with higher operating time [MD 44.73, (95%CI 36.01, 53.45) p < 0.00001] and less intraoperative blood loss [MD -18.24, (95%CI -25.21, -11.26) p < 0.00001] and lower rate of surgical complication in terms of Dindo-Clavien ≥ 3 classification [OR 0.66, (95%CI 0.49, 0.88) p = 0.005]. With respect to oncological outcomes, the RG group showed a significantly increased mean number of retrieved lymph nodes [MD 1.84, (95%CI 0.84, 2.84) p = 0.0003], but mean proximal and distal resection margin distance and the recurrence rate were not significantly different between the two approaches. CONCLUSIONS With respect to safety, technical feasibility and oncological adequacy, robotic and laparoscopic groups were comparable, although the robotic approach seems to achieve better short-term surgical outcomes. Moreover, a higher rate of retrieved lymph nodes was observed in the RG group.
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Yang C, Shi Y, Xie S, Chen J, Zhao Y, Qian F, Hao Y, Tang B, Yu P. Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study. BMC Cancer 2020; 20:669. [PMID: 32680479 PMCID: PMC7367399 DOI: 10.1186/s12885-020-07160-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 07/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. METHODS We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. RESULTS After PSM, the RATG group had a longer mean operation time (291.14 ± 59.18 vs. 270.34 ± 52.22 min, p = 0.003), less intraoperative bleeding (154.37 ± 89.68 vs. 183.77 ± 95.39 ml, p = 0.004) and more N2 tier RLNs (9.07 ± 5.34 vs. 7.56 ± 4.50, p = 0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90 ± 13.05 vs. 31.91 ± 12.46, p = 0.065). Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p = 0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55 and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p = 0.145), and the ratio of splenectomy were 1.59 and 0.39% (p = 0.253). The mortality rates were 0.8 and 0.4% for the RATG and LATG groups, respectively (p = 1.000). CONCLUSION This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.
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Affiliation(s)
- Changdong Yang
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Yan Shi
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Shaohui Xie
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Jun Chen
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Yongliang Zhao
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Feng Qian
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Yingxue Hao
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Bo Tang
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Peiwu Yu
- Department of General Surgery, Southwest Hospital, Army Medical University, 30 Gaotanyan Street, Shapingba District, 400038, Chongqing, China.
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Alshuaibi M, Perrenot C, Hubert J, Perez M. Concurrent, face, content, and construct validity of the RobotiX Mentor simulator for robotic basic skills. Int J Med Robot 2020; 16:e2100. [PMID: 32112491 DOI: 10.1002/rcs.2100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess several criteria, such as concurrent, face, content, and construct validity of the RobotiX Mentor (RXM) simulator for basic robotic skills and to compare virtual and actual dry lab dome. METHODS A prospective study was conducted from December 2017 to May 2018 using RXM and a da Vinci Si robot. 37 subjects, divided into three groups according to their initial surgical training (expert, intermediate, and novice), were evaluated in terms of six representative exercises of basic robotic specific skills as recommended by the fundamentals of robotic surgery. RESULTS There was a correlation between the automatic data from the RXM and the subjective evaluation with the robot. The face and content validity, which were evaluated by the experts, were generally considered high (71.5% and 62.5%, respectively). Three levels (analysis of variance [ANOVA]; P = .01) and two levels (P = .001) of experience were clearly identified by the simulator. CONCLUSION Our study proves the concurrent validity and confirms the face, content, and construct validity of the RXM.
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Affiliation(s)
- Muaath Alshuaibi
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,Department of Urology, Hospital University, Ha'il, Saudi Arabia
| | - Cyril Perrenot
- School of Surgery, Faculty of Medicine, Lorraine University, Vandœuvre-lès-Nancy, France.,Department of Visceral, Metabolic and Cancerology Surgery, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Jacques Hubert
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,School of Surgery, Faculty of Medicine, Lorraine University, Vandœuvre-lès-Nancy, France.,IADI Laboratory, INSERM-U1254, Nancy University, Vandœuvre-lès-Nancy, France
| | - Manuela Perez
- Department of Visceral, Metabolic and Cancerology Surgery, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,IADI Laboratory, INSERM-U947, Nancy University, Vandœuvre-lès-Nancy, France
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Kong Y, Cao S, Liu X, Li Z, Wang L, Lu C, Shen S, Zhu H, Zhou Y. Short-Term Clinical Outcomes After Laparoscopic and Robotic Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis. J Gastrointest Surg 2020; 24:531-539. [PMID: 30937714 DOI: 10.1007/s11605-019-04158-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/05/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The different advantages of laparoscopic gastrectomy (LG) and robotic gastrectomy (RG), two new minimally invasive surgical techniques for gastric cancer, remain controversial. PURPOSE To compare the short-term clinical outcomes of LG and RG. METHODS A retrospective, single-center comparative study of 1044 patients (LG = 750, RG = 294) was conducted. Patients undergoing LG and RG were matched (2:1 ratio) according to sex, age, BMI, extent of gastric resection, and pathologic stage. The primary outcomes were morbidity and mortality and perioperative recovery parameters; major types of complications were also analyzed. RESULTS After matching, 798 patients (LG = 532, RG = 266) were included. Both the LG and RG groups showed similar overall complication rates (LG = 12.8% vs RG = 12.4%) and operative mortality (LG = 0.4% vs RG = 0.4%). Compared to those who underwent LG, patients undergoing RG had significantly longer operative times (236.92 ± 57.28 vs 217.77 ± 65.00 min, p < 0.001), higher total costs (US$16,241.42 vs US$12,497, p < 0.001), less operative blood loss (77.07 ± 64.37 vs 103.68 ± 86.92 ml, p < 0.001), higher numbers of retrieved lymph nodes (32.0 vs 29.9, p < 0.001), and higher rates of retrieving more than 16 lymph nodes (94.0 vs 85.5%; p < 0.001). No significant differences between groups were noted in terms of the rate of reoperation, time until a soft diet was consumed, or length of hospital stay. The major complication and readmission rates were similar in both groups. CONCLUSION RG and LG produced similar short-term clinical outcomes, indicating that RG is a safe and beneficial surgical procedure.
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Affiliation(s)
- Ying Kong
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China.,Department of Gastrointestinal Surgery, Jining No. 1 People's Hospital, No. 6 Jiankang Road, Central District, Jining City, 272013, Shandong Province, People's Republic of China.,Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 16# Hehua Road, Beihu New District, Jining City, 272067, Shandong, People's Republic of China
| | - Shougen Cao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Xiaodong Liu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Zequn Li
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Liankai Wang
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Cunlong Lu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Shuai Shen
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Houxin Zhu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Yanbing Zhou
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China.
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