Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China.
Int J Oncol. 2019 Sep;55(3):733-744. doi: 10.3892/ijo.2019.4851. Epub 2019 Jul 30.
The present ambispective cohort study was performed to compare the short‑term surgical outcomes, including financial cost and surgeons' acceptance, of robotic versus three‑dimensional high‑definition (3D‑HD) laparoscopic gastrectomy for patients with gastric cancer (GC). Between 2011 and 2017, 517 patients with GC were enrolled for treatment with either robotic gastrectomy [408 patients, including 73 treated by one of the authors (LC)] or 3D‑HD laparoscopic gastrectomy (109 patients, including 71 treated by LC). The cumulative summation method was developed to analyze the learning curves of robotic and 3D‑HD laparoscopic gastrectomy performed by LC. In the analysis of all 517 patients, there were no significant differences in the clinicopathological characteristics between the two treatment groups, with the exception of smoking status (P<0.001). The robotic group had a shorter operative time (OT; 209 vs. 228 min, P=0.004), fewer postoperative days (PODs) to first flatus (3 vs. 4 days, P=0.025), more PODs to removal of the drainage and nasogastric tubes (12 vs. 9 days, P=0.001; 6 vs. 4 days, P=0.001, respectively), and more postoperative complications (21.3 vs. 9.2%, P=0.003). Comparison of these short‑term outcomes of robotic and 3D‑HD laparoscopic gastrectomy performed by LC (144 patients) revealed that only the number of retrieved lymph nodes (27 in the robotic group vs. 33 in the 3D‑HD group; P=0.038) and PODs to removal of the nasogastric tube (5 days in the robotic group vs. 3 days in the 3D‑HD group; P<0.001) were significantly different. The OT stabilized after around 21 robotic gastrectomy procedures and 19 3D‑HD laparoscopic gastrectomy procedures. The cost‑effectiveness analysis revealed that robotic gastrectomy had a significantly higher total cost than 3D‑HD laparoscopic gastrectomy (124,907 vs. 94,395 RMB, P<0.001). With comparable surgical outcomes, lower financial cost and higher surgeons' acceptance, 3D‑HD laparoscopic gastrectomy is highly recommended as a minimally invasive surgical method for patients with GC prior to the popularization of robotic surgery.
本前瞻性队列研究旨在比较机器人与三维高清（3D-HD）腹腔镜胃癌根治术的短期手术结果，包括经济成本和外科医生的接受程度。2011 年至 2017 年间，共纳入 517 例胃癌患者接受治疗，其中机器人胃癌根治术 408 例（包括作者之一（LC）治疗的 73 例），3D-HD 腹腔镜胃癌根治术 109 例（包括 LC 治疗的 71 例）。采用累积和法分析 LC 行机器人和 3D-HD 腹腔镜胃癌根治术的学习曲线。在对所有 517 例患者的分析中，两组患者的临床病理特征无显著差异，除外吸烟状态（P<0.001）。机器人组手术时间更短（209 分钟 vs. 228 分钟，P=0.004），术后首次肛门排气时间更短（3 天 vs. 4 天，P=0.025），引流管和鼻胃管拔除时间更短（12 天 vs. 9 天，P=0.001；6 天 vs. 4 天，P=0.001），术后并发症更多（21.3% vs. 9.2%，P=0.003）。比较 LC 行机器人和 3D-HD 腹腔镜胃癌根治术的短期结果（144 例），仅发现淋巴结清扫数目（机器人组 27 枚 vs. 3D-HD 组 33 枚；P=0.038）和鼻胃管拔除时间（机器人组 5 天 vs. 3D-HD 组 3 天；P<0.001）有显著差异。机器人胃癌根治术的手术时间在大约完成 21 例和 19 例后趋于稳定。3D-HD 腹腔镜胃癌根治术。成本效益分析显示，机器人胃癌根治术的总费用明显高于 3D-HD 腹腔镜胃癌根治术（124907 元 vs. 94395 元，P<0.001）。与手术结果相当，3D-HD 腹腔镜胃癌根治术具有较低的经济成本和较高的外科医生接受度，推荐作为 GC 患者的微创治疗方法，在机器人手术普及之前。
