在胃癌D2淋巴结清扫中，采用一种新型的胰上前瞻性入路且不横断十二指肠的机器人远端胃切除术。

Robotic distal gastrectomy using a novel pre-emptive supra-pancreatic approach without duodenal transection in the dissection of D2 lymph nodes for gastric cancer.

作者信息

Xie Jianming, Yang Jiabin, Wang Meixiao, Yin Yongfang, Yan Zhilong

机构信息

Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China.

出版信息

Front Oncol. 2024 May 28;14:1388626. doi: 10.3389/fonc.2024.1388626. eCollection 2024.

DOI:10.3389/fonc.2024.1388626

PMID:38863643

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11165139/

Abstract

BACKGROUND

Robot-assisted surgery has shown remarkable progress as a minimally invasive procedure for gastric cancer. This study aimed to compare the pre-emptive suprapancreatic approach without duodenal transection and the conventional approach in terms of perioperative feasibility and short-term surgical outcomes.

METHODS

We retrospectively analyzed all patients who underwent robotic distal gastrectomy with D2 lymph node dissection using the da Vinci Xi robotic system between December 2021 and April 2023 and categorized them into two groups for comparison. Patients treated using the pre-emptive suprapancreatic approach (observation group) were compared with those who received the conventional approach (control group). Employing one-to-one propensity score matching, we evaluated the postoperative morbidity and short-term outcomes in these two distinct groups to assess the efficacy and safety of the novel surgical technique.

RESULTS

This study enrolled 131 patients: 70 in the observation group and 61 in the control group. After propensity score matching, the operative times were significantly longer in the control group than in the observation group (229.10 ± 33.96 vs. 174.84 ± 18.37, p <0.001). The mean blood loss was lower in the observation group than in the control group (25.20 ± 11.18 vs. 85.00 ± 38.78, p <0.001). Additionally, the observation group exhibited a higher number of retrieved lymph nodes, including suprapyloric, perigastric, and superior pancreatic lymph nodes (28.69 ± 5.48 vs. 19.21 ± 2.89, p <0.001; 4.98 ± 1.27 vs. 4.29 ± 1.21, p = 0.012; 10.52 ± 2.39 vs. 5.50 ± 1.62, p <0.001; 6.26 ± 2.64 vs. 5.00 ± 1.72, p = 0.029). Drain amylase levels in the observation group were significantly lower than those in the control group (30.08 ± 33.74 vs. 69.14 ± 66.81, p <0.001).

CONCLUSION

This study revealed that using the pre-emptive suprapancreatic approach without duodenal transection in the dissection of D2 lymph nodes for gastric cancer is a safe and feasible procedure in terms of surgical outcomes.

摘要

背景

机器人辅助手术作为一种胃癌微创手术已取得显著进展。本研究旨在比较不进行十二指肠横断的预防性胰上区入路与传统入路在围手术期的可行性和短期手术效果。

方法

我们回顾性分析了2021年12月至2023年4月期间使用达芬奇Xi机器人系统接受机器人辅助远端胃癌根治术并进行D2淋巴结清扫的所有患者，并将他们分为两组进行比较。将采用预防性胰上区入路治疗的患者（观察组）与接受传统入路的患者（对照组）进行比较。采用一对一倾向评分匹配，我们评估了这两个不同组的术后发病率和短期结局，以评估这种新型手术技术的疗效和安全性。

结果

本研究共纳入131例患者：观察组70例，对照组61例。倾向评分匹配后，对照组的手术时间显著长于观察组（229.10±33.96 vs. 174.84±18.37，p<0.001）。观察组的平均失血量低于对照组（25.20±11.18 vs. 85.00±38.78，p<0.001）。此外，观察组获取的淋巴结数量更多，包括幽门上、胃周和胰上淋巴结（28.69±5.48 vs. 19.21±2.89，p<0.001；4.98±1.27 vs. 4.29±1.21，p = 0.012；10.52±2.39 vs. 5.50±1.62，p<0.001；6.26±2.64 vs. 5.00±1.72，p = 0.029）。观察组的引流淀粉酶水平显著低于对照组（30.08±33.74 vs. 69.14±66.81，p<0.001）。