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机器人手术与腹腔镜手术治疗胃癌:短期手术结果比较

Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes.

作者信息

Shen Weisong, Xi Hongqing, Wei Bo, Cui Jianxin, Bian Shibo, Zhang Kecheng, Wang Ning, Huang Xiaohui, Chen Lin

机构信息

Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.

出版信息

Surg Endosc. 2016 Feb;30(2):574-580. doi: 10.1007/s00464-015-4241-7. Epub 2015 Jul 25.

Abstract

BACKGROUND

Robot-assisted gastrectomy (RAG) is a new minimally invasive surgical technique for gastric cancer. This study was designed to compare RAG with laparoscopy-assisted gastrectomy (LAG) in short-term surgical outcomes.

METHODS

Between October 2011 and August 2014, 423 patients underwent robotic or laparoscopic gastrectomy for gastric cancer: 93 RAG and 330 LAG. We performed a comparative analysis between RAG group and LAG group for clinicopathological characteristics and short-term surgical outcomes.

RESULTS

RAG was associated with a longer operative time (P < 0.001), lower blood loss (P = 0.001), and more harvested lymph nodes (P = 0.047). Only three patients in LAG group had positive margins, and R0 resection rate for RAG and LAG was similar (P = 0.823). The RAG group had postoperative complications of 9.8 %, comparable with those of the LAG group (P = 0.927). Proximal margin, distal margin, hospital stay, days of first flatus, and days of eating liquid diet for RAG and LAG were similar. In the subgroup of serosa-negative patients, RAG had a longer operation time (P = 0.003), less intraoperative blood loss (P = 0.005), and more harvested lymph nodes (P = 0.04). However, in the subgroup of serosa-positive patients, RAG had a longer operation time (P = 0.001), but no less intraoperative blood loss (P = 0.139) and no more harvested lymph nodes (P = 0.139). Similarly, in the subgroup of total gastrectomy patients, RAG had a longer operation time (P = 0.018), but no less intraoperative blood loss (P = 0.173).

CONCLUSIONS

The comparative study demonstrates that RAG is as acceptable as LAG in terms of surgical and oncologic outcomes. With lower estimated blood loss, acceptable complications, and radical resection, RAG is a promising approach for the treatment of gastric cancer. However, the indication of patients for RAG is critical.

摘要

背景

机器人辅助胃癌切除术(RAG)是一种用于胃癌的新型微创手术技术。本研究旨在比较RAG与腹腔镜辅助胃癌切除术(LAG)的短期手术效果。

方法

2011年10月至2014年8月期间,423例患者接受了机器人或腹腔镜胃癌切除术:93例RAG和330例LAG。我们对RAG组和LAG组的临床病理特征和短期手术效果进行了比较分析。

结果

RAG与手术时间较长(P < 0.001)、失血量较少(P = 0.001)以及获取的淋巴结较多(P = 0.047)相关。LAG组仅3例患者切缘阳性,RAG和LAG的R0切除率相似(P = 0.823)。RAG组术后并发症发生率为9.8%,与LAG组相当(P = 0.927)。RAG和LAG的近端切缘、远端切缘、住院时间、首次排气天数和进食流食天数相似。在浆膜阴性患者亚组中,RAG手术时间较长(P = 0.003),术中失血量较少(P = 0.005),获取的淋巴结较多(P = 0.04)。然而,在浆膜阳性患者亚组中,RAG手术时间较长(P = 0.001),但术中失血量并不少(P = 0.139),获取的淋巴结也不多(P = 0.139)。同样,在全胃切除患者亚组中,RAG手术时间较长(P = 0.018),但术中失血量并不少(P = 0.173)。

结论

比较研究表明,RAG在手术和肿瘤学效果方面与LAG一样可接受。RAG估计失血量较低、并发症可接受且能根治性切除,是一种有前景的胃癌治疗方法。然而,RAG患者的适应证至关重要。

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