Wang Daosheng, Cao Shougen, Tan Xiaojie, Liu Shanglong, Liu Xiaodong, Niu Zhaojian, Chen Dong, Wang Dongsheng, Zhang Jian, Lv Liang, Li Yu, Jiang Haitao, Guo Dong, Li Yi, Li Zequn, Zhou Yanbing
Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University,Qingdao 266003,China.
Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University,Qingdao 266003,China, Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Feb 25;22(2):156-163.
To compare the effects of robotic and laparoscopic-assisted radical total gastrectomy on lymph node dissection and short-term outcomes in patients with Siewert type II adenocarcinoma of esophagogastric junction (AEG).
Inclusion criteria: the tumor center was located between 2 cm above and below the esophagogastric junction and was confirmed as adenocarcinoma by endoscopic biopsy.
tumor with local invasion of the liver,spleen, pancreas or other organs; intraoperative finding of tumor dissemination or distant metastasis; patients undergoing palliative surgical treatment or preoperative neoadjuvant chemotherapy; patients with serious heart diseases, lung diseases, liver diseases, kidney diseases and other comorbidities; patients with multiple primary cancers;patients receiving emergency surgery. According to the above criteria, 82 patients with Siewert type II AEG who underwent gastrointestinal surgery at the Affiliated Hospital of Qingdao University from October 2014 to October 2018 were enrolled in the study. They were randomly divided into robotic surgery groups (41 cases) and laparoscopic group (41 cases) according to a computer-generated randomized allocation table. Both groups underwent radical total gastrectomy plus D2 lymph node dissection through the transabdominal esophageal hiatus approach. The intraoperative conditions and postoperative short-term outcomes were compared between two groups, including surgery time, intraoperative blood loss, length of esophagectomy, postoperative complications, postoperative gastrointestinal recovery time, length of hospital stay, postoperative unplanned reoperation rate and rehospitalization rate. Mean±SD is used for the measurement data that conforms to the normal distribution, and two independent sample t-tests are used to compare the two groups; the comparison of the count data is performed by the χ² test.
There were 35 males (85.4%) with age of (62.3±10.0) years and body mass index of (24.4±3.2) kg/m² in the robotic surgery group. There were 37 males (90.2%) with age of (62.5±10.0) years and body mass index of (23.8±2.6) kg/m² in the laparoscopic group. No significant differences in the baseline data between two groups were found (all P>0.05). All the patients of both groups completed R0 resection successfully without conversion to laparotomy or perioperative death. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss [(70.7±39.9) ml vs. (110.2±70.6) ml, t=3.118, P=0.003], longer resected esophagus [(3.0±0.7) cm vs. (1.9±0.5) cm, t=8.759, P<0.001], but longer setup time [(56.5±7.4) minutes vs. (36.0±6.6) minutes, t=4.241, P<0.001], and higher hospitalization costs [(122 317.31±57 789.33) yuan vs. (99 401.56±39 349.53) yuan, t=2.099, P=0.039], whose differences were statistically significant (all P<0.05). The total number of harvested lymph node in the robotic surgery group was 39.2±15.3,which was significantly higher than that in the laparoscopic group (33.0±12.1) (t=0.733, P=0.047). In the robotic group and the laparoscopic group, the mediastinal lymph node No.110 and No.111 were 3.6±1.2 vs. 1.5±1.0 and 3.7±2.0 vs. 1.8±1.1, respectively, with significant difference (t=10.138, P<0.001, t=8.227, P<0.001); axillary lymph node No.19 and No.20 were 2.3±1.2 vs. 1.1±0.9 and 2.0±1.0 vs. 1.0±0.1, respectively, with significant difference (t=7.082, P<0.001,t=8.672,P<0.001). There were no significant differences in the total number of abdominal lymph node and the number of lymph node in abdominal stations between two group (all P>0.05). The highest lymph node metastasis rate was approximately 20% and observed in No.1, No.2, No.3, and No.7, followed by No.8a, No.9, No.11p, and No.110 with around 5%. The lymph node metastasis rate in other stations (No.4sa, No.4sb, No.4d, No.5, No.6, No.11d, No.12a, No.19, No.20 and No.111) was less than 5%.There were no significant differences in postoperative complication rate, postoperative fever time, postoperative exhaust and defecation time, fluid diet time, and postoperative hospital stay (all P>0.05). There were 2 patients(4.9%) with unplanned reoperation and 1 patient (2.4%) with unplanned re-admission in the laparoscopic group,while 3 patients (7.3%)with unplanned reoperation and 2 patients (4.9%)with unplanned re-admission in the robotic surgery group, whose differences were also not statistically significant (χ²=0.240,P=0.675;χ²=0.346,P=1.000).
Robot-assisted radical total gastrectomy for Siewert II AEG is safe and feasible, which is characterized by more sophisticated operation, less blood loss and higher quality of lymph node dissection, especially for subphrenic and inferior mediastinal lymph nodes.
比较机器人辅助根治性全胃切除术与腹腔镜辅助根治性全胃切除术治疗食管胃交界部（AEG）SiewertⅡ型腺癌患者时，对淋巴结清扫及短期预后的影响。
纳入标准：肿瘤中心位于食管胃交界部上下2cm之间，经内镜活检确诊为腺癌。
肿瘤侵犯肝脏、脾脏、胰腺或其他器官；术中发现肿瘤播散或远处转移；接受姑息性手术治疗或术前新辅助化疗的患者；患有严重心脏病、肺病、肝病、肾病及其他合并症的患者；患有多原发性癌症的患者；接受急诊手术的患者。根据上述标准，选取2014年10月至2018年10月在青岛大学附属医院接受胃肠手术的82例SiewertⅡ型AEG患者纳入研究。根据计算机生成的随机分配表将其随机分为机器人手术组（41例）和腹腔镜组（41例）。两组均经腹食管裂孔入路行根治性全胃切除术加D2淋巴结清扫术。比较两组患者的术中情况及术后短期预后，包括手术时间、术中出血量、食管切除长度、术后并发症、术后胃肠道恢复时间、住院时间、术后非计划性再次手术率和再住院率。符合正态分布的计量资料采用均数±标准差表示，两组间比较采用两独立样本t检验；计数资料的比较采用χ²检验。
机器人手术组有男性35例（85.4%），年龄（62.3±10.0）岁，体重指数（24.4±3.2）kg/m²。腹腔镜组有男性37例（90.2%），年龄（62.5±10.0）岁，体重指数（23.8±2.6）kg/m²。两组患者基线资料比较，差异均无统计学意义（均P>0.05）。两组患者均成功完成R0切除，无中转开腹或围手术期死亡。与腹腔镜组比较，机器人手术组术中出血量少[（70.7±39.9）ml比（110.2±70.6）ml，t=3.118，P=0.003]，食管切除长度长[（3.0±0.7）cm比（1.9±0.5）cm，t=8.759，P<0.001]，但手术准备时间长[（56.5±7.4）分钟比（36.0±6.6）分钟，t=4.241，P<0.001]，住院费用高[（122 317.31±57 789.33）元比（99 401.56±39 349.53）元，t=2.099，P=0.
