Balbona Joseph, Chen Liwei, Malafa Mokenge P, Hodul Pamela J, Dineen Sean P, Mehta Rutika, Mhaskar Rahul S, Pimiento José M
USF Morsani College of Medicine, Tampa, Florida.
USF Morsani College of Medicine, Department of Medical Education, Tampa, Florida.
J Surg Res. 2020 Aug;252:30-36. doi: 10.1016/j.jss.2020.01.023. Epub 2020 Mar 26.
Robotic-assisted gastrectomy is increasingly utilized for the treatment of gastric malignancies. However, the benefits of robotic surgery have been questioned. This study describes short-term outcomes in the establishment of a comprehensive robotic program for gastric malignancies.
Patients who underwent robotic-assisted gastric resections between 2013 and 2018 were studied. Preoperative measures and surgical outcomes were analyzed. Finally we studied and analyzed robotic and open gastrectomy for the management of gastric adenocarcinoma (GC) at the same institution between 2000 and 2018 for quality benchmarking.
Forty six patients (pts.) underwent robotic-assisted gastric resections. 26 (56.5%) were male, with a median age of 62 y (range: 29-87). Pathology included GC, gastrointestinal stromal tumors, neuroendocrine tumors, metastatic lesions, and benign processes. 19 pts. underwent total gastrectomy, 16 distal gastrectomy, four subtotal gastrectomy, and seven wedge resection. Pts. undergoing distal gastrectomy and wedge resection experienced shorter operative times and length of stay than total gastrectomy (P < 0.01; P < 0.01). Four operations (8.8%) were converted to open and 13 pts (28.3%) had postoperative complications, including an 8.7% readmission rate. Median lymph nodes retrieved during total, subtotal, and distal gastrectomy were 20 (13-46), 12.5 (0-26), and 16.5 (0-34), respectively. All pts. underwent margin negative resection. Median follow-up for GC was 21 mo, and 60% of pts. received adjuvant therapy at a median of 59d (range: 23-106).
Robotic gastrectomy is a feasible alternative to open gastrectomy. Our results will help establish benchmarks to improve perioperative outcomes, especially length of stay and time to initiation of therapy.
机器人辅助胃切除术越来越多地用于治疗胃恶性肿瘤。然而，机器人手术的益处受到了质疑。本研究描述了建立一个针对胃恶性肿瘤的综合机器人手术项目的短期结果。
对2013年至2018年间接受机器人辅助胃切除术的患者进行研究。分析术前指标和手术结果。最后，我们研究并分析了2000年至2018年间在同一机构进行的机器人辅助胃切除术和开放胃切除术治疗胃腺癌（GC）的情况，以进行质量基准对比。
46例患者接受了机器人辅助胃切除术。26例（56.5%）为男性，中位年龄62岁（范围：29 - 87岁）。病理类型包括GC、胃肠道间质瘤、神经内分泌肿瘤、转移性病变和良性病变。19例患者接受了全胃切除术，16例接受远端胃切除术，4例接受次全胃切除术，7例接受楔形切除术。接受远端胃切除术和楔形切除术的患者手术时间和住院时间比全胃切除术短（P < 0.01；P < 0.01）。4例手术（8.8%）转为开放手术，13例患者（28.3%）有术后并发症，包括8.7%的再入院率。全胃、次全胃和远端胃切除术期间切除的中位淋巴结数分别为20个（13 - 46个）、12.5个（0 - 26个）和16.5个（0 - 34个）。所有患者均接受了切缘阴性切除术。GC患者的中位随访时间为21个月，60%的患者在中位时间59天（范围：从23 - 106天）接受了辅助治疗。
机器人胃切除术是开放胃切除术的一种可行替代方法。我们的结果将有助于建立基准，以改善围手术期结果，特别是住院时间和开始治疗的时间。
