机器人胃切除术项目实施期间的短期和教科书式手术结果。
Short-Term and Textbook Surgical Outcomes During the Implementation of a Robotic Gastrectomy Program.
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
J Gastrointest Surg. 2023 Jun;27(6):1089-1097. doi: 10.1007/s11605-023-05627-7. Epub 2023 Mar 14.
BACKGROUND
Whether gastric cancer patients derive greater benefit from robotic gastrectomy (RG), or open gastrectomy (OG) is unknown. We initiated a RG program in 2018, with prospective short-term outcome monitoring to ensure safety. We hypothesized that the RG program for gastric cancer can be safely implemented with equivalent safety and oncological textbook outcomes (TOs) to conventional open gastrectomy (OG).
METHODS
The study included patients who underwent curative-intent OG or RG for gastric adenocarcinoma between January 2018 and December 2021. TO metrics were negative surgical margins, ≥ 15 lymph nodes examined, no severe (Clavien-Dindo grade ≥ IIIa) postoperative complications, no reinterventions within 90 days after surgery, no ICU admission, no prolonged length of stay (LOS; > 10 days), no 90-day postoperative mortality, and no readmission within 90 days after surgery. Overall TO was achieved when all these metrics were met.
RESULTS
Of 161 patients, 120 underwent OG, and 41 underwent RG. The two groups' demographic and disease characteristics did not differ significantly. Compared with OG patients, RG patients had a longer median surgery time (348 vs. 282 min), smaller median blood loss volume (50 vs. 150 mL), lower mean prescribed opioid dose at discharge (12 vs. 45 mg), and shorter median LOS (4 vs. 7 days; all p < 0.001). The groups' postoperative complication rates (10% vs. 17%) did not differ significantly (p = 0.283). The overall TO rate of the RG group (73%) was higher than that of the OG group (60%), but the difference was not significant (p = 0.131).
CONCLUSION
We were able to implement the RG program safely, without compromising safety or oncological outcomes.
背景
尚不清楚胃癌患者接受机器人胃切除术（RG）或开腹胃切除术（OG）是否获益更大。我们于 2018 年开展了 RG 项目，并对短期预后进行前瞻性监测以确保安全性。我们假设 RG 项目治疗胃癌的安全性与 OG 相当，并且在肿瘤学方面具有相同的安全性和手术结果（TO）。
方法
该研究纳入了 2018 年 1 月至 2021 年 12 月期间接受根治性 OG 或 RG 治疗的胃腺癌患者。TO 指标包括阴性切缘、≥15 枚淋巴结检出、无严重（Clavien-Dindo 分级≥IIIa）术后并发症、术后 90 天内无需再次手术、无需入住 ICU、无住院时间延长（>10 天）、90 天内无术后死亡和术后 90 天内无再入院。如果满足所有这些指标，则认为总体 TO 达成。
结果
161 例患者中，120 例行 OG，41 例行 RG。两组患者的人口统计学和疾病特征无显著差异。与 OG 患者相比，RG 患者的中位手术时间更长（348 分钟比 282 分钟）、中位出血量更少（50 毫升比 150 毫升）、出院时平均开处阿片类药物剂量更小（12 毫克比 45 毫克）、中位住院时间更短（4 天比 7 天；均 p<0.001）。两组的术后并发症发生率（10%比 17%）无显著差异（p=0.283）。RG 组的总体 TO 率（73%）高于 OG 组（60%），但差异无统计学意义（p=0.131）。
结论
我们能够安全地开展 RG 项目，在不影响安全性和肿瘤学结果的情况下实现这一目标。
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