Hirata Yuki, Chiang Yi-Ju, Mansfield Paul, Badgwell Brian D, Ikoma Naruhiko
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
World J Oncol. 2023 Oct;14(5):371-381. doi: 10.14740/wjon1657. Epub 2023 Sep 20.
Robotic gastrectomy (RG) has been increasingly used for treatment of gastric cancer in the United States. However, it is unknown if there has been a nationwide improvement of short-term safety outcomes and oncological quality metrics over time.
We used the National Cancer Database to identify patients who underwent major gastrectomy from 2010 through 2018. The short-term safety outcomes and oncological metrics were compared between cases of open gastrectomy (OG), laparoscopic gastrectomy (LG), and RG. We also compared the indications and outcomes of RG between the three periods (2010 - 2012, 2013 - 2015, and 2016 - 2018).
Of the 22,445 patients included, 1,867 (8%) underwent RG. Number of RG continued to increase from only 37 cases performed in 2010 to 412 cases performed in 2018. The number of lymph nodes (LNs) examined (OG, 16; LG, 17; and RG, 19) and the R0 rate (OG, 88%; LG, 92%; and RG 94%) were better for RG than for OG or LG (P < 0.001). In the RG group, the number of LNs examined (first period, 15; third period, 18; P < 0.001), R0 rate (first period, 88.6%; third period, 91.1%; P < 0.001), length of hospital stay (first period, 9 days; third period, 8 days; P < 0.001), 30-day readmission rate (first period, 10.1%; third period, 7.9%; P < 0.001), and 90-day mortality (first period, 7.3%; third period, 6.0%; P = 0.003) continued to improve cohort over time. The ratio of the robotic cases performed in academic institutions gradually increased (first period, 48.6%; third period, 54.3%; P < 0.001). In multivariable analyses, RG was associated with more than 15 LNs being examined (OR, 1.49; 95% CI, 1.34 - 1.65; P < 0.001). The indications for RG appeared expanding to include more advanced stage, high comorbidity, and patients who underwent preoperative therapy.
RG has been increasingly performed in the past decade. Although its indication was expanded to include more advanced tumors, we found that the oncological quality metrics and safety outcomes of RG have improved over time and were better than those of OG or LG.
在美国，机器人辅助胃癌切除术（RG）已越来越多地用于治疗胃癌。然而，短期安全结局和肿瘤学质量指标是否随时间推移在全国范围内得到改善尚不清楚。
我们使用国家癌症数据库来识别2010年至2018年期间接受大胃癌切除术的患者。比较了开放胃癌切除术（OG）、腹腔镜胃癌切除术（LG）和RG病例的短期安全结局和肿瘤学指标。我们还比较了三个时期（2010 - 2012年、2013 - 2015年和2016 - 2018年）RG的适应证和结局。
在纳入的22445例患者中，1867例（8%）接受了RG。RG的例数从2010年的仅37例持续增加到2018年的412例。RG组检查的淋巴结（LN）数量（OG为16个；LG为17个；RG为19个）和R0切除率（OG为88%；LG为92%；RG为94%）优于OG或LG（P < 0.001）。在RG组中，检查的LN数量（第一时期为15个；第三时期为18个；P < 0.001）、R0切除率（第一时期为88.6%；第三时期为91.1%；P < 0.001）、住院时间（第一时期为9天；第三时期为8天；P < 0.001）、30天再入院率（第一时期为10.1%；第三时期为7.9%；P < 0.001）和90天死亡率（第一时期为7.3%；第三时期为6.0%；P = 0.003）随时间推移在队列中持续改善。学术机构进行的机器人手术病例比例逐渐增加（第一时期为48.6%；第三时期为54.3%；P < 0.001）。在多变量分析中，RG与检查超过15个LN相关（OR，1.49；95%CI，1.34 - 1.65；P < 0.001）。RG的适应证似乎在扩大，包括更晚期阶段、高合并症以及接受术前治疗的患者。
在过去十年中，RG的应用越来越多。尽管其适应证扩大到包括更晚期肿瘤，但我们发现RG的肿瘤学质量指标和安全结局随时间推移有所改善，且优于OG或LG。
