Kubo Naoshi, Sakurai Katsunobu, Hasegawa Tsuyoshi, Tamamori Yutaka, Iseki Yasuhito, Nishii Takafumi, Shimizu Sadatoshi, Inue Toru, Nishiguchi Yukio, Maeda Kiyoshi
Department of Gastroenterological Surgery Osaka City General Hospital Osaka Japan.
Department of Gastroenterological Surgery Osaka Metropolitan University Graduate School of Medicine Osaka Japan.
Ann Gastroenterol Surg. 2023 Oct 11;8(2):221-233. doi: 10.1002/ags3.12748. eCollection 2024 Mar.
The efficacy of robotic gastrectomy (RG) on postoperative complications in patients with gastric cancer (GC) is unclear in terms of the volume of intra-abdominal fat tissue.
We enrolled 403 patients with GC who had minimally invasive surgery between January 2015 and July 2022. During this time, 197 RG and 206 laparoscopic gastrectomies (LG) were performed on the study participants. According to the computed tomography scan, patients were defined as having or not having visceral obesity based on the visceral fatty area (VFA). In each high and low VFA group, we compared short-term outcomes between the RG group and LG group.
After PS matching for patients with high VFA, the two groups were well matched, with 71 cases in both the RG and LG groups. The median surgical time in the RG group was significantly longer (420 vs. 365 min, < 0.001). However, the RG group had a significantly lower rate of severe intra-abdominal infectious complications (IAIC), such as anastomotic leakage, pancreatic fistula, and intra-abdominal abscess (1.4% vs. 15.4%, = 0.004). However, among the 77 patients with low VFA values, we found no significant difference in the rate of severe IAIC between the two groups (1.1% in the RG group vs. 2.6% in the LG group, = 1.00).
RG may be a viable alternative to LG because of the lower postoperative IAIC for patients with visceral obesity and GC. However, RG may not benefit non-obese patients.
就腹腔内脂肪组织量而言，机器人胃癌切除术（RG）对胃癌（GC）患者术后并发症的疗效尚不清楚。
我们纳入了2015年1月至2022年7月间接受微创手术的403例GC患者。在此期间，对研究参与者进行了197例RG和206例腹腔镜胃癌切除术（LG）。根据计算机断层扫描，根据内脏脂肪面积（VFA）将患者定义为有或没有内脏肥胖。在每个高VFA组和低VFA组中，我们比较了RG组和LG组之间的短期结局。
对高VFA患者进行倾向评分匹配后，两组匹配良好，RG组和LG组均有71例。RG组的中位手术时间明显更长（420对365分钟，<0.001）。然而，RG组严重腹腔内感染并发症（IAIC）的发生率显著较低，如吻合口漏、胰瘘和腹腔内脓肿（1.4%对15.4%，=0.004）。然而，在77例VFA值低的患者中，我们发现两组之间严重IAIC的发生率没有显著差异（RG组为1.1%，LG组为2.6%，=1.00）。
对于内脏肥胖和GC患者，RG术后IAIC较低，可能是LG的一个可行替代方案。然而，RG可能对非肥胖患者没有益处。
