Maegawa Felipe B, Patel Ankit D, Patel Snehal G, Stetler Jamil L, Patel Dipan C, Ashouri Yazan, Sarmiento Juan M, Konstantinidis Ioannis T, Lin Edward
Division of General & Gastrointestinal Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA.
Saint Vincent Medical Center, Mercy Health, Toledo, OH, USA.
Surg Endosc. 2023 Dec;37(12):9643-9650. doi: 10.1007/s00464-023-10519-7. Epub 2023 Nov 9.
Surgery remains the cornerstone treatment for gastric cancer. Previous studies have reported better lymphadenectomy with minimally invasive approaches. There is a paucity of data comparing robotic and laparoscopic gastrectomy in the US. Herein, we examined whether oncological adequacy differs between laparoscopic and robotic approaches.
The National Cancer Database was utilized to identify patients who underwent gastrectomy for adenocarcinoma between 2010 and 2019. A propensity score-matching analysis between robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) was performed. The primary outcomes were lymphadenectomy ≥ 16 nodes and surgical margins.
A total of 11,173 patients underwent minimally invasive surgery for gastric adenocarcinoma between 2010 and 2019. Of those 8320 underwent LG and 2853 RG. Comparing the unmatched cohorts, RG was associated with a higher rate of adequate lymphadenectomy (63.5% vs 57.1%, p < .0.0001), higher rate of negative margins (93.8% vs 91.9%, p < 0.001), lower rate of prolonged length of stay (26.0% vs 29.6%, p < .0.001), lower 90-day mortality (3.7% vs 5.0%, p < 0.0001), and a better 5-year overall survival (OS) (56% vs 54%, p = 0.03). A propensity score-matching cohort with a 1:1 ratio was created utilizing the variables associated with lymphadenectomy ≥ 16 nodes. The matched analysis revealed that the rate of adequate lymphadenectomy was significantly higher for RG compared to LG, 63.5% vs 60.4% (p = 0.01), respectively. There was no longer a significant difference between RG and LG regarding the rate of negative margins, prolonged length of stay, 90-day mortality, rate of receipt of postoperative chemotherapy, and OS.
This propensity score-matching analysis with a large US cohort shows that RG was associated with a higher rate of adequate lymphadenectomy compared to LR. RG and LG had a similar rate of negative margins, prolonged length of stay, receipt of postoperative chemotherapy, 90-day mortality, and OS, suggesting that RG is a comparable surgical approach, if not superior to LG.
手术仍然是胃癌的基石性治疗方法。既往研究报道，微创方法可实现更好的淋巴结清扫。在美国，比较机器人辅助与腹腔镜胃切除术的数据较少。在此，我们研究了腹腔镜和机器人辅助手术在肿瘤学切除充分性方面是否存在差异。
利用国家癌症数据库确定2010年至2019年间接受腺癌胃切除术的患者。对机器人辅助胃切除术（RG）与腹腔镜胃切除术（LG）进行倾向评分匹配分析。主要结局为淋巴结清扫≥16枚及手术切缘情况。
2010年至2019年间，共有11173例患者接受了微创胃癌手术。其中8320例行LG，2853例行RG。比较未匹配队列，RG组的充分淋巴结清扫率更高（63.5%对57.1%，p<0.0001），切缘阴性率更高（93.8%对91.9%，p<0.001），住院时间延长率更低（26.0%对29.6%，p<0.001），90天死亡率更低（3.7%对5.0%，p<0.0001），5年总生存率更好（56%对54%，p=0.03）。利用与淋巴结清扫≥16枚相关的变量创建了1:1比例的倾向评分匹配队列。匹配分析显示，RG组的充分淋巴结清扫率显著高于LG组，分别为63.5%和60.4%（p=0.01）。RG组和LG组在切缘阴性率、住院时间延长率、90天死亡率、术后化疗接受率和总生存率方面不再存在显著差异。
这项对美国一大群患者的倾向评分匹配分析表明，与LG相比，RG的充分淋巴结清扫率更高。RG和LG在切缘阴性率、住院时间延长率、术后化疗接受率、90天死亡率和总生存率方面相似，这表明RG即使不优于LG，也是一种可比较的手术方法。
Zotero 插件