Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189, Rome, Italy.
Division of General Surgery, Department of Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100, Arezzo, Italy.
J Robot Surg. 2021 Oct;15(5):741-749. doi: 10.1007/s11701-020-01168-2. Epub 2020 Nov 5.
Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥ 65 or 75 years is used. Even if robot-assisted surgery is a validated option for the elderly population, there are no specific indications for its application in the surgical treatment of gastric cancer. The aim of this study is to evaluate the safety and feasibility of robot-assisted gastrectomy and to compare the short and long-term outcomes of robot-assisted (RG) versus open gastrectomy (OG). Patients aged ≥ 70 years old undergoing surgery for gastric cancer at the Department of Surgery of San Donato Hospital in Arezzo, between September 2012 and March 2017 were enrolled. A 1:1 propensity score matching was performed according to the following variables: age, Sex, BMI, ASA score, comorbidity, T stage and type of resection performed. 43 OG were matched to 43 RG. The mean operative time was significantly longer in the RG group (273.8 vs. 193.5 min, p < 0.01). No differences were observed in terms of intraoperative blood loss, an average number of lymph nodes removed, mean hospital stay, morbidity and mortality. OG had higher rate of major complications (6.9 vs. 16.3%, OR 2.592, 95% CI 0.623-10.785, p = 0.313) and a significantly higher postoperative pain (0.95 vs. 1.24, p = 0.042). Overall survival (p = 0.263) and disease-free survival (p = 0.474) were comparable between groups. Robotic-assisted surgery for oncological gastrectomy in elderly patients is safe and effective showing non-inferiority comparing to the open technique in terms of perioperative outcomes and overall 5-year survival.
虽然对于老年人的定义尚未达成共识,但通常使用年龄界限≥65 岁或 75 岁。即使机器人辅助手术是老年人群的一种有效选择,但是在胃癌的外科治疗中,并没有特别指出机器人辅助手术的适应证。本研究旨在评估机器人辅助胃切除术的安全性和可行性,并比较机器人辅助(RG)与开放性胃切除术(OG)的短期和长期结果。在阿雷佐圣多纳托医院外科部门,于 2012 年 9 月至 2017 年 3 月期间,纳入年龄≥70 岁且接受胃癌手术的患者。根据以下变量进行 1:1 倾向评分匹配:年龄、性别、BMI、ASA 评分、合并症、T 分期和进行的切除术类型。将 43 例 OG 与 43 例 RG 相匹配。RG 组的手术时间明显长于 OG 组(273.8 分钟比 193.5 分钟,p<0.01)。两组术中出血量、平均淋巴结清扫数、平均住院时间、发病率和死亡率无差异。OG 的主要并发症发生率更高(6.9%比 16.3%,OR 2.592,95%CI 0.623-10.785,p=0.313),术后疼痛程度更高(0.95 比 1.24,p=0.042)。两组总生存(p=0.263)和无病生存(p=0.474)无差异。在老年患者中,机器人辅助手术治疗肿瘤性胃切除术是安全有效的,与开放性手术相比,在围手术期结果和总 5 年生存率方面具有非劣效性。