Anderson Casandra, Ellenhorn Joshua, Hellan Minia, Pigazzi Alessio
Department of Surgical Oncology, City of Hope, 1500 Duarte Road, Duarte, CA 91010, USA.
Surg Endosc. 2007 Sep;21(9):1662-6. doi: 10.1007/s00464-007-9266-0. Epub 2007 Mar 8.
Robotic surgery is evolving as a therapeutic tool for thoracic and urologic applications; however, its use in gastric cancer surgery has not been extensively reported. The objective of this pilot series was to assess the feasibility of using robotic surgery in performing an extended lymphadenectomy for gastric cancer.
Between June 2005 and July 2006, seven patients (3 female, 4 male) underwent combined laparoscopic subtotal gastrectomy with omentectomy and robot-assisted extended lymphadenectomy using the da Vinci Surgical System for early distal gastric tumors. The mean age of the patients was 64 years. Tumor staging ranged from 0 to II. Six patients had adenocarcinoma and one patient had a high-grade dysplastic adenoma.
All procedures were completed successfully without conversion. The median operating time was 420 min. There was one intraoperative complication requiring a colon resection for a devascularized segment. The median number of nodes harvested was 24 (range = 17-30). Resection margins were negative in all specimens. Patients were hospitalized a median of 4 days (range = 3-9). Thirty-day mortality was 0%. Patients resumed a solid diet a median of 4 days postoperatively. Median followup was 9 (range = 0-10) months. There have been no tumor recurrences to date.
Extended lymphadenectomy for gastric cancer using robotic surgery is safe and allows for an adequate lymph node retrieval. Our preliminary results suggest that this novel technique offers short hospital stays and low morbidity for patients undergoing surgical resection of distal gastric malignancies. Future studies will be necessary to better define the role of robotic surgery in gastric cancer treatment.
机器人手术正逐渐发展成为一种用于胸科和泌尿外科手术的治疗工具；然而，其在胃癌手术中的应用尚未得到广泛报道。本系列初步研究的目的是评估使用机器人手术进行胃癌扩大淋巴结清扫术的可行性。
2005年6月至2006年7月期间，7例患者（3例女性，4例男性）接受了腹腔镜辅助远端胃次全切除术、大网膜切除术以及使用达芬奇手术系统进行的机器人辅助扩大淋巴结清扫术，治疗早期远端胃癌。患者的平均年龄为64岁。肿瘤分期为0至II期。6例患者患有腺癌，1例患者患有高级别发育异常性腺瘤。
所有手术均成功完成，无需中转开腹。中位手术时间为420分钟。有1例术中并发症，需要对一段缺血的结肠进行切除。中位清扫淋巴结数目为24枚（范围 = 17 - 30枚）。所有标本的切缘均为阴性。患者的中位住院时间为4天（范围 = 3 - 9天）。30天死亡率为0%。患者术后中位4天恢复正常饮食。中位随访时间为9个月（范围 = 0 - 10个月）。迄今为止，尚无肿瘤复发。
使用机器人手术进行胃癌扩大淋巴结清扫术是安全的，并且能够获取足够数量的淋巴结。我们的初步结果表明，这种新技术可为接受远端胃癌手术切除的患者提供较短的住院时间和较低的发病率。未来有必要开展进一步研究，以更好地明确机器人手术在胃癌治疗中的作用。
