Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan.
Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8535, Ishikawa, Japan.
World J Gastroenterol. 2021 Oct 21;27(39):6659-6672. doi: 10.3748/wjg.v27.i39.6659.
Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer. Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades. Thus far, only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.
To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.
This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period. After excluding 125 patients with non-curative surgery ( = 77), other synchronous cancer ( = 2), remnant gastric cancer ( = 25), insufficient physical function ( = 13), and open gastrectomy ( = 8), a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined. Accordingly, 5-year overall and recurrence-free survival were analyzed using the Kaplan-Meier method with the log-rank test and Cox regression analyses, while factors associated with survival were determined using multivariate analysis.
Our analysis showed that age > 65 years, American Society of Anesthesiologists (ASA) physical status 3, total or proximal gastrectomy, and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrence-free survival. Accordingly, the included patients had a 5-year overall and recurrence-free survival of 80.3% and 78.2%, respectively. Among the 814 patients, 157 (19.3%) underwent robotic gastrectomy, while 308 (37.2%) were diagnosed with pathological stage II or III disease. Notably, our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III [hazard ratio: 0.56 (0.33-0.96), = 0.035]. Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity ( = 0.005).
Age, ASA status, gastrectomy type, and pathological T and N status were prognostic factors of minimally invasive gastrectomy, with the robot approach possibly improving long-term outcomes of advanced gastric cancer.
胃癌是全球导致死亡的第三大癌症原因，手术切除仍然是胃癌的唯一治愈性治疗方法。微创胃切除术包括腹腔镜和机器人方法，在过去几十年中得到了越来越多的应用。到目前为止，只有少数报道研究了微创胃切除术后的肿瘤学结果。
确定微创胃切除术治疗胃癌的 5 年生存率，并确定预后预测因素。
本回顾性队列研究纳入了在研究期间接受胃切除术治疗胃癌的 939 名患者。排除 125 例非治愈性手术（ = 77）、其他同步癌症（ = 2）、残胃癌（ = 25）、体力不足（ = 13）和开放胃切除术（ = 8）后，回顾性分析了我院 2009 年至 2014 年间接受微创 R0 胃切除术的 814 例原发性胃癌连续患者。因此，使用 Kaplan-Meier 方法和对数秩检验以及 Cox 回归分析分析了 5 年总生存率和无复发生存率，使用多变量分析确定了与生存相关的因素。
我们的分析表明，年龄 > 65 岁、美国麻醉医师协会（ASA）身体状况 3 级、全胃或近端胃切除术以及病理 T4 和 N 阳性状态是 5 年总生存率和无复发生存率的独立预测因素。因此，纳入的患者 5 年总生存率和无复发生存率分别为 80.3%和 78.2%。在 814 例患者中，157 例（19.3%）接受了机器人胃切除术，308 例（37.2%）被诊断为病理 II 期或 III 期疾病。值得注意的是，我们的研究结果表明，机器人胃切除术是病理 II/III 期患者无复发生存的独立阳性预测因素[风险比：0.56（0.33-0.96）， = 0.035]。使用倾向评分匹配分析比较机器人和腹腔镜方法的无复发生存率，验证了机器人组的发病率较低（ = 0.005）。
年龄、ASA 状态、胃切除术类型以及病理 T 和 N 状态是微创胃切除术的预后因素，机器人方法可能改善晚期胃癌的长期预后。
