General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Int J Med Robot. 2021 Apr;17(2):e2212. doi: 10.1002/rcs.2212. Epub 2021 Jan 8.
To compare outcomes of robotic gastrectomy (RG) performed during the learning curve (P1) with those after its completion (P2).
In this retrospective study, all consecutive RG patients (n = 92) performed between 2008 and 2018 were included. Primary outcome was conversion rate.
D2 lymphadenectomies were more common in P2 (41, 97.6%) than P1 (41, 82.0%) (p = 0.019). Conversions were 11 (22%) in P1 versus 2 (4.8%) in P2 (p = 0.006). Postoperative morbidity was comparable between the groups. Median hospital stay was significantly shorter in P2. The only factor significantly associated with conversion was P2 (odds ratio = 0.18; 95% confidence interval, 0.04-0.85; p = 0.039). The 5-year overall survival in P1 was 79.6% versus 79.7% in P2 (p = 0.373).
The learning curve affected operative and postoperative outcomes: during the learning curve, conversion to open surgery was significantly more frequent, the number of D2 was higher and patients were discharged earlier.
比较机器人胃切除术（RG）在学习曲线（P1）期间和完成后（P2）的结果。
在这项回顾性研究中，纳入了 2008 年至 2018 年间连续进行的所有 RG 患者（n=92）。主要结果是转化率。
P2 组行 D2 淋巴结清扫术的比例（41 例，97.6%）高于 P1 组（41 例，82.0%）（p=0.019）。P1 组有 11 例（22%）中转开腹，而 P2 组仅有 2 例（4.8%）（p=0.006）。两组术后并发症发生率相当。P2 组的中位住院时间明显缩短。唯一与转化率显著相关的因素是 P2（优势比=0.18；95%置信区间，0.04-0.85；p=0.039）。P1 组的 5 年总生存率为 79.6%，P2 组为 79.7%（p=0.373）。
学习曲线影响手术和术后结果：在学习曲线期间，中转开腹的发生率显著增加，D2 清扫的数量更高，患者出院更早。
