Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, China.
Langenbecks Arch Surg. 2023 Mar 29;408(1):131. doi: 10.1007/s00423-023-02866-9.
The study's objectives were to compare the short-term outcomes of robotic radical distal gastrectomy (RDG) with laparoscopic radical distal gastrectomy (LDG) for patients with gastric cancer and investigate the learning curve of RDG.
The cumulative sum (CUSUM) method was used to retrospectively analyze consecutive gastric cancer patients undergoing RDG between January 2019 and October 2021. The duration of surgery, clinical-pathological characteristics, and short-term outcomes were evaluated according to the two phases of the learning curve (learning period versus mastery period). We also compared the clinical-pathological characteristics and short-term outcomes between cases in the mastery period and LDG.
Data from 290 patients were included in this analysis, 135 RDG and 155 LDG cases. The learning period was 20 cases. There were no significant differences in clinical-pathological characteristics between the learning period and mastery period. Compared with the learning period, the mastery period had a significant reduction in total operation time, docking time, pure operation time, and estimated blood loss, and a significant increase in hospital costs (P=0.000, 0.000, 0.000, 0.003, and 0.026, respectively). Compared with LDG, robotic cases in mastery period had a longer operative time, shorter first postoperative flatus time, and more hospital costs (P=0.000, 0.005, and 0.000, respectively).
RGD may fasten to recover gastrointestinal function faster after the operation, can be mastered easily after a reasonable number of cases, and was associated with safe and satisfactory short-term outcomes before and after the learning curve.
本研究旨在比较机器人辅助远端胃癌根治术（RDG）与腹腔镜辅助远端胃癌根治术（LDG）治疗胃癌患者的短期疗效，并探讨 RDG 的学习曲线。
采用累积和（CUSUM）法回顾性分析 2019 年 1 月至 2021 年 10 月连续接受 RDG 的胃癌患者。根据学习曲线的两个阶段（学习期和掌握期）评估手术时间、临床病理特征和短期疗效。我们还比较了掌握期病例与 LDG 的临床病理特征和短期疗效。
共纳入 290 例患者，其中 135 例行 RDG，155 例行 LDG。学习期为 20 例。学习期和掌握期的临床病理特征无显著差异。与学习期相比，掌握期的总手术时间、对接时间、纯手术时间和估计出血量显著减少，住院费用显著增加（P=0.000、0.000、0.000、0.003 和 0.026）。与 LDG 相比，掌握期机器人手术时间更长，首次术后肛门排气时间更短，住院费用更高（P=0.000、0.005 和 0.000）。
RDG 可能加快术后胃肠道功能恢复，在合理数量的病例后易于掌握，并且在学习曲线前后具有安全和满意的短期疗效。
