Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Departments of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2022 Sep;29(9):5861-5870. doi: 10.1245/s10434-022-11836-2. Epub 2022 May 4.
Minimally invasive, robotic gastrectomy is associated with better short-term outcomes and quicker functional recovery. However, the degree to which the robotic approach influences postoperative pain and opioid use after gastrectomy is unknown. Our primary aim was to determine whether the robotic approach to gastrectomy reduces postoperative opioid use compared with the open approach.
Patients who underwent gastrectomy (November 2018 to September 2021) were identified retrospectively. Clinical characteristics, short-term surgical outcomes, oral morphine equivalent (OME) use, and pain scores were collected. Both groups were managed through an enhanced recovery program in the perioperative period.
Of 81 patients, 50 underwent open and 31 underwent robotic gastrectomy. Compared with open gastrectomy patients, robotic gastrectomy patients had longer surgery time (360 vs. 288 min), less blood loss (50 vs. 138 mL), and shorter hospital stay (4 vs. 6 days) (all medians, P < 0.001). Robotic gastrectomy patients used lower OMEs on postoperative days 0-4 (all P < 0.05) and in total for days 0-4 (total mean dose 65.0 vs. 169.5 mg; P < 0.001) than did open gastrectomy patients. The robotic gastrectomy patients were prescribed a lower mean OME dose than the open gastrectomy patients (19.0 vs. 29.0 mg, respectively; P = 0.001). Multivariable analysis showed that robotic approach was associated with lower opioid use (odds ratio 3.70; 95% CI 1.01-14.3; P = 0.049).
Compared with open gastrectomy, robotic gastrectomy reduces opioid use in the early postoperative period and is associated with fewer OME discharge prescriptions and shorter hospital stay.
微创机器人辅助胃切除术与更好的短期结果和更快的功能恢复相关。然而，机器人手术对胃切除术后疼痛和阿片类药物使用的影响程度尚不清楚。我们的主要目的是确定机器人辅助胃切除术是否比开放手术减少术后阿片类药物的使用。
回顾性地确定了 2018 年 11 月至 2021 年 9 月期间接受胃切除术的患者。收集了临床特征、短期手术结果、口服吗啡当量（OME）使用和疼痛评分。两组患者在围手术期均通过强化康复方案进行管理。
在 81 名患者中，50 名接受了开放胃切除术，31 名接受了机器人胃切除术。与开放胃切除术患者相比，机器人胃切除术患者的手术时间更长（360 分钟 vs. 288 分钟）、失血量更少（50 毫升 vs. 138 毫升）和住院时间更短（4 天 vs. 6 天）（中位数，均 P<0.001）。机器人胃切除术患者在术后第 0-4 天（所有 P<0.05）和第 0-4 天总（总平均剂量 65.0 毫克 vs. 169.5 毫克；P<0.001）使用的 OME 较少。机器人胃切除术患者的 OME 处方剂量也低于开放胃切除术患者（分别为 19.0 毫克 vs. 29.0 毫克；P=0.001）。多变量分析显示，机器人方法与较低的阿片类药物使用相关（优势比 3.70；95%置信区间 1.01-14.3；P=0.049）。
与开放胃切除术相比，机器人胃切除术可减少术后早期阿片类药物的使用，减少 OME 出院处方的数量，并缩短住院时间。
