Xie S H, Shi Y, Long D, Chen J, Zhao Y L, Qian F, Hao Y X, Tang B, Li P A, Yu P W
Department of General Surgery, The First Affiliated Hospital, The Army Medical University, Chongqing 400038, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Apr 25;23(4):357-363. doi: 10.3760/cma.j.cn.441530-20200113-00021.
To analyze long-term outcomes and prognostic factors of gastric cancer patients after robotic radical total gastrectomy. A retrospective case-control study was conducted. Inclusion criteria: (1) receiving robotic radical total gastrectomy; (2) gastric adenocarcinoma was confirmed by postoperative pathology; (3) no previous history of other malignant tumors; (4) no preoperative chemotherapy or radiation therapy performed. Exclusion criteria: (1) age <18 years old or age >80 years old;(2)distant metastasis before surgery, or palliative surgery; (3) conversion to laparotomy;(4) R1 or R2 resection; (5)emergency surgery; (6) remnant gastric cancer or recurrence; (7)died of severe complications during hospitalization or within 1 month after surgery. Overall survival rates (OS) and disease-free survival rates (DFS) were evaluated using the Kaplan-Meier method. Cox regression analysis was used to identify prognosis factors for overall survival. According to the above criteria, 166 gastric cancer patients who underwent robotic radical total gastrectomy between March 2010 and November 2018 were included in this study. Roux-en-Y reconstruction was performed in all patients. Reconstruction were achieved using extracorporeal method through a minilaparotomy in 149 case and intracorporeal anastomosis in 17 cases. The number of harvested lymph nodes was (34.8±17.5), and the number of harvested lymph nodes at group 2 was (10.1±6.7). The number of patients with lymph node metastasis of group 2 was 73 (44.0%). The median follow-up time was 25 months (range 2-109). There were 55 (33.1%) cases of recurrence during follow-up. The 3- and 5-year overall survival rates were 55.8% and 46.2% respectively. The 3- and 5-year disease-free survival rates were 53.4% and 45.4% respectively. The 5-year overall survival rates grouped based on TNM stage were 78.9% for stage I, 58.5% for stage II, and 37.1% for stage III. The 5-year disease-free survival rates grouped based on TNM stage were 78.9% for stage I, 59.2% for stage II, and 34.6% for stage III. Univariate analysis suggested that TNM stage, the number of harvested lymph nodes and number of harvested lymph nodes at group 2 were associated with overall survival rates (all <0.05). Multivariate analyses revealed that TNM stage (<0.001; stage IIIB: HR=5.357, 95%CI:1.182 to 24.275; stage IIIC: HR=11.937, 95%CI: 2.677 to 53.226) and number of harvested lymph nodes at group 2 (=0.034; 6-10: HR=0.562,95%CI:0.326 to 0.969; >10: HR=0.388, 95%CI: 0.176 to 0.857) were independent prognostic factors for overall survival. The long-term outcomes of robotic radical total gastrectomy were satisfactory. TNM stage and number of harvested lymph nodes at group 2 were independent prognostic factors for overall survival.
分析机器人根治性全胃切除术后胃癌患者的长期预后及预后因素。进行了一项回顾性病例对照研究。纳入标准：（1）接受机器人根治性全胃切除术；（2）术后病理确诊为胃腺癌；（3）既往无其他恶性肿瘤病史；（4）未进行术前化疗或放疗。排除标准：（1）年龄<18岁或>80岁；（2）术前远处转移或姑息性手术；（3）中转开腹；（4）R1或R2切除；（5）急诊手术；（6）残胃癌或复发；（7）住院期间或术后1个月内死于严重并发症。采用Kaplan-Meier法评估总生存率（OS）和无病生存率（DFS）。采用Cox回归分析确定总生存的预后因素。根据上述标准，本研究纳入了2010年3月至2018年11月期间接受机器人根治性全胃切除术的166例胃癌患者。所有患者均行Roux-en-Y重建。149例采用体外法经小切口完成重建，17例采用体内吻合。清扫淋巴结数为（34.8±17.5）枚，第2组清扫淋巴结数为（10.1±6.7）枚。第2组有73例（44.0%）发生淋巴结转移。中位随访时间为25个月（范围2-109个月）。随访期间有55例（33.1%）复发。3年和5年总生存率分别为55.8%和46.2%。3年和5年无病生存率分别为53.4%和45.4%。根据TNM分期分组的5年总生存率，I期为78.9%，II期为58.5%，III期为37.1%。根据TNM分期分组的5年无病生存率，I期为78.9%，II期为59.2%，III期为34.6%。单因素分析提示TNM分期、清扫淋巴结数及第2组清扫淋巴结数与总生存率相关（均<0.05）。多因素分析显示TNM分期（<0.001；IIIB期：HR=5.357，95%CI：1.182至24.275；IIIC期：HR=11.937，95%CI：2.677至53.226）及第2组清扫淋巴结数（=0.034；6-10枚：HR=0.562，95%CI：0.326至0.969；>10枚：HR=0.388，95%CI：0.176至0.857）是总生存的独立预后因素。机器人根治性全胃切除术的长期预后良好。TNM分期及第2组清扫淋巴结数是总生存的独立预后因素。
