Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
Surg Endosc. 2022 Aug;36(8):6223-6234. doi: 10.1007/s00464-022-09125-w. Epub 2022 Feb 28.
The benefits of robotic gastrectomy (RG) over laparoscopic gastrectomy (LG) remain controversial. This single-center, propensity score-matched study aimed to compare the outcomes of RG with those of LG for treating gastric cancer.
We searched the prospective gastric cancer database of our institute for patients with gastric cancer who underwent RG or LG between January 2014 and December 2019, excluding patients with remnant stomach cancer and those who underwent concurrent surgery for comorbid malignancies. One-to-one propensity score matching was performed to reduce bias from confounding patient-related variables, and short- and long-term outcomes were compared between the groups.
We identified 1189 patients who underwent LG (n = 979) or RG (n = 210). After propensity score matching, we selected 210 pairs of patients who underwent LG (distal gastrectomy, 138; total or proximal gastrectomy, 72) or RG (distal gastrectomy, 143; total or proximal gastrectomy, 67). RG was associated with a significantly shorter operative time (RG = 201 min vs. LG = 231 min, p = 0.0051), less blood loss (RG = 13 mL vs. LG = 42 mL, p < 0.0001), lower postoperative morbidity (RG = 1.0% vs. LG = 4.8%, p = 0.0066), and a shorter postoperative hospital stay (p = 0.0002) than LG. Drain amylase levels on postoperative Days 1 and 3 in the RG group were significantly lower than those in the LG group (p < 0.0001).
RG is a safe and feasible treatment for gastric cancer, with a shorter operative time, less blood loss, and lower postoperative morbidity than LG. The application of robotics in minimally invasive gastric cancer surgery may offer an alternative to conventional surgery. Multicenter, prospective, randomized controlled trials comparing RG with conventional LG are needed to establish the feasibility and efficacy of minimally invasive gastric cancer surgery.
机器人胃切除术（RG）相较于腹腔镜胃切除术（LG）的优势仍存在争议。本单中心、倾向评分匹配研究旨在比较 RG 与 LG 治疗胃癌的疗效。
我们检索了我院前瞻性胃癌数据库中 2014 年 1 月至 2019 年 12 月期间接受 RG 或 LG 的胃癌患者资料，排除残胃癌和合并恶性肿瘤同期手术患者。采用 1:1 倾向评分匹配以减少混杂患者相关变量的偏倚，并比较两组的短期和长期疗效。
我们共纳入 1189 例接受 LG（n=979）或 RG（n=210）治疗的患者。经倾向评分匹配后，我们选择了 210 对接受 LG（远端胃切除术 138 例，全胃或近端胃切除术 72 例）或 RG（远端胃切除术 143 例，全胃或近端胃切除术 67 例）的患者。与 LG 相比，RG 具有更短的手术时间（RG=201 分钟 vs. LG=231 分钟，p=0.0051）、更少的术中出血量（RG=13 毫升 vs. LG=42 毫升，p<0.0001）、更低的术后并发症发生率（RG=1.0% vs. LG=4.8%，p=0.0066）和更短的术后住院时间（p=0.0002）。RG 组术后第 1、3 天引流淀粉酶水平显著低于 LG 组（p<0.0001）。
RG 治疗胃癌是安全可行的，与 LG 相比，具有更短的手术时间、更少的术中出血量和更低的术后并发症发生率。机器人技术在微创胃癌手术中的应用可能为传统手术提供替代方案。需要开展多中心、前瞻性、随机对照临床试验，比较 RG 与传统 LG 治疗胃癌的可行性和疗效。
