Shibasaki Susumu, Suda Koichi, Hisamori Shigeo, Obama Kazutaka, Terashima Masanori, Uyama Ichiro
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Gastric Cancer. 2023 May;26(3):325-338. doi: 10.1007/s10120-023-01389-y. Epub 2023 Apr 3.
Robotic gastrectomy (RG) using the da Vinci Surgical System for gastric cancer was approved for national medical insurance coverage in Japan in April 2018, and its number has been rapidly increasing since then.
We reviewed and compared current evidence on RG and conventional laparoscopic gastrectomy (LG) to identify the differences in surgical outcomes.
Three independent reviewers systematically reviewed the data collected from a comprehensive literature search by an independent organization, focusing on the following nine endpoints: mortality, morbidity, operative time, estimated blood loss volume, length of postoperative hospital stay, long-term oncologic outcome, quality of life, learning curve, and cost.
Compared to LG, RG has lower intraoperative blood loss volume, shorter length of hospital stay, and shorter learning curve, but both procedures have similar mortality. Contrarily, its disadvantages include longer procedural time and higher costs. Although the morbidity rate and long-term outcomes are almost comparable, RG showed superior potentials. Currently, the outcomes of RG are considered comparable to or better than LG.
RG might be applicable to all gastric cancer patients who fulfill the indication of LG at institutions that meet specific criteria and are approved to claim the National Health Insurance costs for the use of the surgical robot in Japan.
2018年4月，使用达芬奇手术系统进行的机器人胃癌切除术（RG）在日本被批准纳入国家医疗保险覆盖范围，自那时起其数量迅速增加。
我们回顾并比较了目前关于RG和传统腹腔镜胃癌切除术（LG）的证据，以确定手术结果的差异。
三位独立评审员系统地回顾了从一个独立组织进行的全面文献检索中收集的数据，重点关注以下九个终点：死亡率、发病率、手术时间、估计失血量、术后住院时间、长期肿瘤学结果、生活质量、学习曲线和成本。
与LG相比，RG术中失血量更少、住院时间更短、学习曲线更短，但两种手术的死亡率相似。相反，其缺点包括手术时间更长和成本更高。虽然发病率和长期结果几乎相当，但RG显示出更好的潜力。目前，RG的结果被认为与LG相当或更好。
在日本符合特定标准并被批准申请使用手术机器人的国家健康保险费用的机构中，RG可能适用于所有符合LG适应症的胃癌患者。
