Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Surg Oncol. 2020 Dec;35:22-23. doi: 10.1016/j.suronc.2020.07.007. Epub 2020 Aug 6.
Safety and efficacy of robotic surgery in advanced gastric cancers (AGC) have not been proven by randomized control trials (Ojima et al., 2018) [1], and therefore, standard procedure for AGC is still open surgery. Robotic surgery, however, plays an essential role in ergonomics and offers advantages, such as motion scaling, tremor filtering, seven degrees of wrist-like motion, and three-dimensional vision. Here, we initially report successful robotic gastric cancer surgery on a 49-year-old male with proximal gastric cancer adherent to tail of pancreas and mesentery of the colon.
The patient underwent a diagnostic laparoscopy 10 days before surgery, confirming negative peritoneal dissemination and washing cytology. The patient was placed in a supine position and we inserted five ports. We performed robotic D2 total gastrectomy with en-mass removal of the spleen and body and tail of the pancreas using the da Vinci Xi Surgical System (Intuitive, Sunnyvale, CA) (Japanese Gastric Cancer Association, 2017) [2]. After gastrectomy, to evaluate the blood supply of transverse colon, we employed Indocyanine Green fluorescence using the da Vinci Firefly system and performed a partial resection of the transverse colon and a colostomy. In order to avoid anastomotic leakage of colocolostomy due to pancreatic fistula, we chose to have end colostomy. Roux-en-Y esophago-jejunostomy and jejuno-jejunostomy reconstruction were performed robotically (Ojima et al., 2019) [3]. After the operation, a nasal feeding tube was inserted.
The operation took 472 min with no intraoperative complications and blood loss of 105 ml. Final pathological examination showed poorly-differentiated adenocarcinoma (T4BN1M0, TNM stage IIIC). The patient was discharged uneventfully on postoperative day 25. He is receiving adjuvant chemotherapy. At six months, there was no evidence of complications or recurrence.
Robotic D2 total gastrectomy with en-mass distal pancreatectomy and splenectomy are feasible and safe in advanced gastric cancer, however, its oncological value has yet to be determined.
机器人手术在进展期胃癌（AGC）中的安全性和有效性尚未通过随机对照试验（Ojima 等人，2018）[1]得到证实，因此，AGC 的标准手术仍为开腹手术。然而，机器人手术在人体工程学方面发挥着重要作用，并具有运动缩放、震颤过滤、七自由度腕式运动和三维视觉等优势。在这里，我们首次报告了一例成功的机器人胃癌手术，患者为 49 岁男性，患有近端胃癌，与胰腺尾部和结肠系膜粘连。
患者在手术前 10 天接受了诊断性腹腔镜检查，确认无腹膜播散和腹腔冲洗细胞学阴性。患者取仰卧位，插入五个端口。我们使用达芬奇 Xi 手术系统（直觉公司，加利福尼亚州森尼韦尔）（日本胃癌协会，2017）[2]进行机器人 D2 全胃切除术，整块切除脾脏和胰腺体尾部。胃切除术后，为评估横结肠的血供，我们使用达芬奇萤火虫系统进行吲哚菁绿荧光检查，并进行部分横结肠切除术和结肠造口术。为了避免因胰瘘导致结肠-结肠吻合口漏，我们选择进行末端结肠造口术。我们还进行了机器人 Roux-en-Y 食管空肠吻合术和空肠空肠吻合术重建（Ojima 等人，2019）[3]。手术后，插入鼻饲管。
手术耗时 472 分钟，无术中并发症，出血量 105ml。最终病理检查显示低分化腺癌（T4BN1M0，TNM 分期 IIIIC）。患者术后第 25 天顺利出院。他正在接受辅助化疗。术后 6 个月，无并发症或复发迹象。
机器人 D2 全胃切除术联合整块胰体尾切除术和脾切除术在进展期胃癌中是可行且安全的，但其肿瘤学价值尚待确定。
