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采用术后加速康复方案的机器人辅助与腹腔镜远端胃癌根治术的手术及短期结局:一项倾向评分匹配分析

Surgical and short-term outcomes in robotic and laparoscopic distal gastrectomy for gastric cancer with enhanced recovery after surgery protocol: A propensity score matching analysis.

作者信息

Huang Weijia, Liu Siyu, Chen Junqiang

机构信息

Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Guangxi Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.

出版信息

Front Surg. 2022 Oct 6;9:944395. doi: 10.3389/fsurg.2022.944395. eCollection 2022.

Abstract

OBJECTIVE

This study aims to evaluate the short-term surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) and robot-assisted distal gastrectomy (RADG) for gastric cancer (GC) with enhanced recovery after surgery (ERAS) protocols.

METHODS

We reviewed the medical records of 202 patients undergoing radical distal gastrectomy; among them, 67 cases were assisted through RADG, while 135 cases were assisted through LADG along with ERAS. We retrospectively collected the medical records in succession from a database (January 2016-March 2019). We adopted propensity score matching to compare surgical and short-term outcomes of both groups.

RESULTS

After the successful examination of 134 cases, including 67 receiving RADG and 67 undergoing LADG, the operative times were noted as 5.78 ± 0.96 h for the RADG group and 4.47 ± 1.01 h for the LADG group ( < 0.001). The blood loss was noted as 125.52 ± 101.18 ml in the RADG group and 164.93 ± 109.32 ml in the LADG group ( < 0.05). The shorter time to first flatus was 38.82 ± 10.56 h in the RADG group and 42.88 ± 11.25 h in the LADG group ( < 0.05). In contrast, shorter days of postoperative hospital stay were 5.94 ± 1.89 days in the RADG group and 6.64 ± 1.92 days in the LADG group ( < 0.05). Also, the RADG group (84483.03 ± 9487.37) was much more costly than the LADG group (65258.13 ± 8928.33) ( < 0.001). The postoperative overall complication rates, numbers of dissected lymph nodes, visual analogue scale (VAS), and time to start a liquid diet for the RADG group and the LADG group were similar.

CONCLUSIONS

In this research, we concluded that RADG provides surgical benefits and short-term outcomes compared to LADG for GC with ERAS.

摘要

目的

本研究旨在评估采用术后加速康复(ERAS)方案的腹腔镜辅助远端胃癌切除术(LADG)和机器人辅助远端胃癌切除术(RADG)治疗胃癌(GC)的短期手术效果。

方法

我们回顾了202例行根治性远端胃癌切除术患者的病历;其中,67例采用RADG辅助,135例采用LADG辅助并实施ERAS。我们从数据库中连续回顾性收集病历(2016年1月至2019年3月)。我们采用倾向评分匹配法比较两组的手术及短期效果。

结果

成功纳入134例患者,其中67例行RADG,67例行LADG,RADG组手术时间为5.78±0.96小时,LADG组为4.47±1.01小时(P<0.001)。RADG组失血量为125.52±101.18毫升,LADG组为164.93±109.32毫升(P<0.05)。RADG组首次排气时间较短,为38.82±10.56小时,LADG组为42.88±11.25小时(P<0.05)。相比之下,RADG组术后住院天数较短,为5.94±1.89天,LADG组为6.64±1.92天(P<0.05)。此外,RADG组(84483.03±9487.37)的费用比LADG组(65258.13±8928.33)高得多(P<0.001)。RADG组和LADG组术后总体并发症发生率、清扫淋巴结数目、视觉模拟评分(VAS)以及开始流食的时间相似。

结论

在本研究中,我们得出结论,对于采用ERAS的GC患者,与LADG相比,RADG具有手术优势和短期效果。

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本文引用的文献

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Japanese gastric cancer treatment guidelines 2018 (5th edition).《日本胃癌治疗指南2018(第5版)》
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