Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.
Surg Endosc. 2022 Mar;36(3):1989-1998. doi: 10.1007/s00464-021-08483-1. Epub 2021 Apr 12.
Robotic gastrectomy (RG) is being increasingly performed globally; it is considered an evolved type of conventional laparoscopic surgery with excellent dexterity and precision, but higher costs and longer operation time. Thus, there is a need to identify the benefits from RG and its specific candidates.
This retrospective study analyzed data from a prospectively collected clinical database at our center. Data of patients with primary gastric cancer undergoing either robotic or laparoscopic radical gastrectomy from June 2014 to June 2020 were reviewed. Surgical outcomes were compared between the two groups, and multivariable analyses were performed to elucidate the relevant factors for postoperative complications in several subgroups.
A total of 1172 patients were divided into those who underwent RG (n = 152) and those who underwent laparoscopic gastrectomy (LG) (n = 1020). Baseline characteristics were similar in the two groups, except the RG group included more patients undergoing total/proximal gastrectomy (TG/PG) and patients at clinical stage III. Compared with the LG group, the RG group had lower incidences of postoperative complications ≥ Clavien-Dindo grade III (2/152 (1.3%) versus 72/1020 (7.1%); P = 0.004), and intraabdominal complications ≥ grade II (6/152 (3.9%) versus 119/1020 (11.7%); P = 0.004). Multivariable analysis revealed that RG was a significant relevant factor for reducing overall postoperative complications (≥ grade III) (odds ratio (OR) 0.16, P = 0.013), and intraabdominal complications (≥ grade II) (OR 0.29, P = 0.002). Subgroup analyses demonstrated that this tendency was enhanced in patients undergoing TG/PG (OR 0.29, P = 0.021) or at clinical stage II/III (OR 0.10, P = 0.027).
RG reduces the incidence of postoperative complications compared with conventional LG and this tendency may be enhanced in technically complicated procedures with demanding anastomosis or D2 lymphadenectomy. Patients requiring such procedures would most benefit from RG.
机器人胃切除术（RG）在全球范围内的应用日益增多；它被认为是一种改良的传统腹腔镜手术，具有出色的灵活性和精准度，但成本更高，手术时间更长。因此，有必要确定 RG 的益处及其特定的适应证。
本回顾性研究分析了我们中心前瞻性收集的临床数据库中的数据。纳入 2014 年 6 月至 2020 年 6 月期间接受机器人或腹腔镜根治性胃切除术的原发性胃癌患者的数据。比较两组患者的手术结果，并进行多变量分析，以阐明几个亚组术后并发症的相关因素。
共有 1172 名患者分为接受 RG（n=152）和腹腔镜胃切除术（LG）（n=1020）的两组。两组患者的基线特征相似，除了 RG 组中接受全胃/近端胃切除术（TG/PG）和临床分期为 III 期的患者比例更高。与 LG 组相比，RG 组术后并发症≥Clavien-Dindo 分级 III（2/152（1.3%）与 72/1020（7.1%）；P=0.004）和腹腔内并发症≥II 级（6/152（3.9%）与 119/1020（11.7%）；P=0.004）的发生率较低。多变量分析显示，RG 是降低总体术后并发症（≥III 级）（比值比（OR）0.16，P=0.013）和腹腔内并发症（≥II 级）（OR 0.29，P=0.002）的显著相关因素。亚组分析表明，这种趋势在接受 TG/PG 手术（OR 0.29，P=0.021）或临床分期为 II/III 期的患者中增强（OR 0.10，P=0.027）。
与传统 LG 相比，RG 降低了术后并发症的发生率，而在需要进行复杂吻合或 D2 淋巴结清扫的手术中，这种趋势可能会增强。需要进行此类手术的患者将从 RG 中获益最大。
