Matsui Kazuaki, Sakuramoto Shinichi, Furube Tasuku, Yoshizawa Masatoshi, Toriumi Tetsuro, Ebara Gen, Miyawaki Yutaka, Sato Hiroshi
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
J Robot Surg. 2025 Apr 10;19(1):143. doi: 10.1007/s11701-025-02296-3.
This study aimed to clarify the clinical benefits of robot-assisted distal gastrectomy (RDG) versus laparoscopic distal gastrectomy (LDG) in patients with obesity.The analysis included 89 and 87 patients in LDG and RDG groups, respectively. The associations between body mass index (BMI) and surgical outcomes including postoperative inflammation were compared between LDG and RDG.Incidences of postoperative complications did not show a significant difference between LDG and RDG. The operating time and blood loss increased with BMI in the LDG group, whereas no such correlation was observed in the RDG group. While BMI and C-reactive protein (CRP) levels on postoperative day (POD) 3 showed a significant correlation in LDG (R = 0.393, p < 0.001), RDG did not show a correlation. In patients with BMI ≥ 25 (kg/m), CRP on POD 3 was significantly lower in RDG than in LDG. Multivariate analysis for CRP on POD 3 in patients with BMI ≥ 25 identified RDG and operating time ≥ 360 min as independent associated factors (B = - 6.887; p = 0.003 and B = 6.068; p = 0.011).RDG was indicated to reduce blood loss and suppress the postoperative CRP elevation compared with LDG, particularly in patients with high BMI.
本研究旨在阐明机器人辅助远端胃切除术（RDG）与腹腔镜远端胃切除术（LDG）相比，对肥胖患者的临床益处。分析分别纳入了LDG组89例患者和RDG组87例患者。比较了LDG组和RDG组中体重指数（BMI）与包括术后炎症在内的手术结局之间的关联。LDG组和RDG组术后并发症的发生率没有显著差异。LDG组的手术时间和失血量随BMI增加而增加，而RDG组未观察到这种相关性。虽然术后第3天（POD 3）的BMI与C反应蛋白（CRP）水平在LDG组中显示出显著相关性（R = 0.393，p < 0.001），但RDG组未显示出相关性。在BMI≥25（kg/m）的患者中，RDG组术后第3天的CRP显著低于LDG组。对BMI≥25的患者术后第3天的CRP进行多因素分析，确定RDG和手术时间≥360分钟为独立相关因素（B = - 6.887；p = 0.003和B = 6.068；p = 0.011）。与LDG相比，RDG被认为可以减少失血量并抑制术后CRP升高，特别是在BMI较高的患者中。
