Woo Yanghee, Hyung Woo Jin, Pak Kyung-Ho, Inaba Kazuki, Obama Kazutaka, Choi Seung Ho, Noh Sung Hoon
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Arch Surg. 2011 Sep;146(9):1086-92. doi: 10.1001/archsurg.2011.114. Epub 2011 May 16.
To evaluate the comparative safety and efficacy of robotic vs laparoscopic gastrectomy for early-stage gastric cancer.
Retrospective analysis.
Tertiary hospital.
Eight hundred twenty-seven patients with gastric cancer.
Between July 2005 and April 2009, 827 patients with gastric cancer underwent 236 robotic and 591 laparoscopic radical gastrectomies with curative intent. The patients' data were prospectively collected and retrospectively analyzed.
We performed a comparative analysis between the robotic surgery group and laparoscopic surgery group for preoperative patient characteristics, intraoperative factors, and postoperative morbidity and mortality.
The robotic group was younger than the laparoscopic group, but other preoperative patient characteristics did not differ. The mean operative time for the robotic group (219.5 minutes) was on average 49 minutes longer than the laparoscopic group (170.7 minutes) (P < .001), while mean blood loss was significantly less in the robotic group (91.6 mL vs 147.9 mL; P = .002). The robotic group had mortality of 0.4% and morbidity of 11.0%, comparable with those of the laparoscopic group (P > .05). The number of lymph nodes retrieved per level was adequate in both groups and did not differ significantly. Robotic D1+α (n = 5), D1+β (n = 126), and D2 (n = 105) dissections retrieved 27.2, 36.7, and 42.4 mean numbers of lymph nodes, respectively. Except for 3 cases in the laparoscopic group, all specimens had negative margins.
Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy. A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery.
评估机器人辅助与腹腔镜胃癌切除术治疗早期胃癌的相对安全性和疗效。
回顾性分析。
三级医院。
827例胃癌患者。
2005年7月至2009年4月期间，827例胃癌患者接受了236例机器人辅助根治性胃切除术和591例腹腔镜根治性胃切除术，均为根治性意图。对患者数据进行前瞻性收集和回顾性分析。
对机器人手术组和腹腔镜手术组的术前患者特征、术中因素以及术后发病率和死亡率进行比较分析。
机器人手术组患者比腹腔镜手术组患者年轻，但其他术前患者特征无差异。机器人手术组的平均手术时间（219.5分钟）比腹腔镜手术组（170.分钟）平均长49分钟（P <.001），而机器人手术组的平均失血量明显较少（91.6 mL对147.9 mL；P =.002）。机器人手术组的死亡率为0.4%，发病率为11.0%，与腹腔镜手术组相当（P >.05）。两组每一层获取的淋巴结数量均足够，且无显著差异。机器人D1+α（n = 5）、D1+β（n = 126）和D2（n = 105）清扫分别平均获取27.2、36.7和42.4枚淋巴结。除腹腔镜手术组有3例患者外，所有标本切缘均为阴性。
我们最大规模的比较研究表明，与腹腔镜胃癌切除术相比，机器人辅助胃癌切除术具有更好的短期效果和相当的肿瘤学结局。机器人辅助胃癌手术是腹腔镜手术的一种有前景的替代方法。
