Tokunaga Masanori, Kaito Akio, Sugita Shizuki, Watanabe Masahiro, Sunagawa Hideki, Kinoshita Takahiro
Gastric Cancer Division, National Cancer Center Hospital East, Kashiwa, Japan.
Transl Gastroenterol Hepatol. 2017 Jun 2;2:57. doi: 10.21037/tgh.2017.05.09. eCollection 2017.
The number of robotic gastrectomy (RG) performed per year has been increasing, particularly in East Asia where the incidence of gastric cancer is high and approximately half of the cases are diagnosed as early gastric cancer. With articulated devices of RG, surgeons are able to perform every procedure more meticulously, which can result in less bleeding and damage to organs. There are many single arm and comparative studies, and these study showed similar trends, which included relatively less estimated blood loss and longer operation time following RG than laparoscopic gastrectomy (LG), equivalent number of harvested lymph nodes and similar length of postoperative hospital stay between RG and LG. Considering the results of these retrospective comparative studies, RG seems to be as feasible as LG in terms of early surgical outcomes. However, medical expense of RG is approximately twice as much as that of LG. Lack of solid evidence in terms of long-term outcomes is another problem. Considering the higher medical expenses associated with RG, its superiority in terms of long-term survival outcomes needs to be confirmed in the future for it to be accepted more widely.
每年实施的机器人胃癌切除术(RG)数量一直在增加,尤其是在胃癌发病率较高的东亚地区,约一半的病例被诊断为早期胃癌。借助RG的关节式器械,外科医生能够更精细地完成每一项操作,这可减少出血和对器官的损伤。有许多单臂研究和对比研究,这些研究显示出类似的趋势,包括RG术后估计失血量相对较少但手术时间比腹腔镜胃癌切除术(LG)长,RG与LG的淋巴结清扫数量相当且术后住院时间相似。考虑到这些回顾性对比研究的结果,就早期手术结果而言,RG似乎与LG一样可行。然而,RG的医疗费用约为LG的两倍。缺乏关于长期结果的确凿证据是另一个问题。鉴于与RG相关的医疗费用较高,其在长期生存结果方面的优势未来需要得到证实,以便更广泛地被接受。