Department of Surgery, University Medical Center (UMC) Utrecht, University of Utrecht, Utrecht, The Netherlands.
Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Florence, Italy.
Ann Surg. 2024 Jul 1;280(1):98-107. doi: 10.1097/SLA.0000000000006147. Epub 2023 Nov 3.
To gain insight into the global practice of robot-assisted minimally invasive gastrectomy (RAMIG) and evaluate perioperative outcomes using an international registry.
The techniques and perioperative outcomes of RAMIG for gastric cancer vary substantially in the literature.
Prospectively registered RAMIG cases for gastric cancer (≥10 per center) were extracted from 25 centers in Europe, Asia, and South-America. Techniques for resection, reconstruction, anastomosis, and lymphadenectomy were analyzed and related to perioperative surgical and oncological outcomes. Complications were uniformly defined by the Gastrectomy Complications Consensus Group.
Between 2020 and 2023, 759 patients underwent total (n=272), distal (n=465), or proximal (n=22) gastrectomy (RAMIG). After total gastrectomy with Roux-en-Y-reconstruction, anastomotic leakage rates were 8% with hand-sewn (n=9/111) and 6% with linear stapled anastomoses (n=6/100). After distal gastrectomy with Roux-en-Y (67%) or Billroth-II-reconstruction (31%), anastomotic leakage rates were 3% with linear stapled (n=11/433) and 0% with hand-sewn anastomoses (n=0/26). Extent of lymphadenectomy consisted of D1+ (28%), D2 (59%), or D2+ (12%). Median nodal harvest yielded 31 nodes (interquartile range: 21-47) after total and 34 nodes (interquartile range: 24-47) after distal gastrectomy. R0 resection rates were 93% after total and 96% distal gastrectomy. The hospital stay was 9 days after total and distal gastrectomy, and was median 3 days shorter without perianastomotic drains versus routine drain placement. Postoperative 30-day mortality was 1%.
This large multicenter study provided a worldwide overview of current RAMIG techniques and their respective perioperative outcomes. These outcomes demonstrated high surgical quality, set a quality standard for RAMIG, and can be considered an international reference for surgical standardization.
通过国际注册中心深入了解全球机器人辅助微创胃切除术（RAMIG）的实践，并评估围手术期结果。
文献中 RAMIG 治疗胃癌的技术和围手术期结果差异很大。
从欧洲、亚洲和南美洲的 25 个中心提取前瞻性注册的 RAMIG 胃癌病例（每个中心≥ 10 例）。分析了切除、重建、吻合和淋巴结清扫的技术，并与围手术期外科和肿瘤学结果相关。并发症由胃癌并发症共识小组统一定义。
2020 年至 2023 年，759 例患者接受了全胃切除术（n=272）、远端胃切除术（n=465）或近端胃切除术（n=22）（RAMIG）。全胃切除术后行 Roux-en-Y 重建，手工吻合吻合口漏发生率为 8%（n=9/111），线性吻合器吻合吻合口漏发生率为 6%（n=6/100）。远端胃切除术后行 Roux-en-Y（67%）或 Billroth-II 重建（31%），线性吻合器吻合吻合口漏发生率为 3%（n=11/433），手工吻合吻合口漏发生率为 0%（n=0/26）。淋巴结清扫范围为 D1+（28%）、D2（59%）或 D2+（12%）。全胃切除术后中位淋巴结采集量为 31 枚（四分位距：21-47 枚），远端胃切除术后为 34 枚（四分位距：24-47 枚）。全胃和远端胃切除术后 R0 切除率分别为 93%和 96%。全胃和远端胃切除术后的住院时间分别为 9 天和 8 天，无吻合口引流管与常规引流管放置相比，中位住院时间缩短 3 天。术后 30 天死亡率为 1%。
这项大型多中心研究提供了全球范围内当前 RAMIG 技术及其各自围手术期结果的概述。这些结果表明手术质量很高，为 RAMIG 设定了质量标准，并可作为手术标准化的国际参考。
