Glenn Jason A, Turaga Kiran K, Gamblin T Clark, Hohmann Samuel F, Johnston Fabian M
Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
University HealthSystem Consortium, 155 N Upper Wacker Dr, Chicago, IL, 60606, USA.
Surg Endosc. 2015 Dec;29(12):3768-75. doi: 10.1007/s00464-015-4152-7. Epub 2015 Mar 20.
Internationally, the utilization of minimally invasive techniques for gastric cancer resection has been increasing since first introduced in 1994. In the USA, the feasibility and safety of these techniques for cancer have not yet been demonstrated.
The University HealthSystem Consortium database was queried for gastrectomies performed between 2008 and 2013. Any adult patient with an abdominal visceral malignancy that necessitated gastric resection was included in the cohort. Clinicopathological and in-hospital outcome metrics were collected for open, laparoscopic, and robotic procedures.
Open gastrectomies comprised 89.5% of the total study group, while 8.2% of procedures were performed laparoscopically, and 2.3% were performed with robotic assistance. When accounting for disparities in patient severity of illness and risk of mortality subclass designations, there were no significant differences in mean length of stay, 30-day readmission, and in-hospital mortality between the three groups; however, mean total cost was highest in the robotic-assisted group (P = 0.017). Overall, complication rates were also similar; however, there was a higher incidence of superficial infection in the laparoscopic group (P = 0.013) and a higher incidence of venous thromboembolism in the robotic group (P = 0.038).
Despite widespread adoption for benign indications, minimally invasive gastrectomy for cancer remains underutilized in the USA. In these patients, laparoscopic and robot-assisted gastrectomies appear to be comparable to open resection with respect to overall complications, length of stay, 30-day readmission, and in-hospital mortality. However, when employing minimally invasive techniques, infection and thromboembolism risk reduction strategies should be emphasized in the operative and postoperative periods.
自1994年首次引入以来，国际上用于胃癌切除的微创技术的应用一直在增加。在美国，这些技术用于癌症治疗的可行性和安全性尚未得到证实。
查询大学卫生系统联盟数据库中2008年至2013年间进行的胃切除术。队列纳入任何因腹部内脏恶性肿瘤需要进行胃切除的成年患者。收集开放手术、腹腔镜手术和机器人辅助手术的临床病理和住院结局指标。
开放胃切除术占整个研究组的89.5%，而8.2%的手术是腹腔镜手术，2.3%是机器人辅助手术。在考虑患者疾病严重程度和死亡风险亚类指定的差异后，三组之间的平均住院时间、30天再入院率和住院死亡率没有显著差异；然而，机器人辅助组的平均总成本最高（P = 0.017）。总体而言，并发症发生率也相似；然而，腹腔镜组浅表感染的发生率较高（P = 0.013），机器人组静脉血栓栓塞的发生率较高（P = 0.038）。
尽管微创胃切除术在良性适应症方面得到广泛应用，但在美国用于癌症治疗的情况仍未得到充分利用。在这些患者中，腹腔镜和机器人辅助胃切除术在总体并发症、住院时间、30天再入院率和住院死亡率方面似乎与开放切除术相当。然而，在采用微创技术时，应在手术期和术后强调降低感染和血栓栓塞风险的策略。
