Düzköylü Yiğit, Gülcan Pınar, Şevik Hüsnü Ozan, Tekin Oğuzhan, Gökduman Hürü Ceren, Karaköse Erdal, Yüksel Sercan, Teke Zafer
Başakşehir Çam and Sakura City Hospital, Department of Gastrointestinal Surgery - İstanbul, Turkey.
Başakşehir Çam and Sakura City Hospital, Department of General Surgery - İstanbul, Turkey.
Rev Assoc Med Bras (1992). 2025 Aug 8;71(7):e20250258. doi: 10.1590/1806-9282.20250258. eCollection 2025.
Robotic surgery has been gaining attention because of the physical and metabolic morbidity of the conventional open technique. The systemic immune-inflammation index has emerged as a recent and more reliable biomarker. In our single-center retrospective cohort study, we investigate systemic immune-inflammation index in robotic gastrectomy in order to show the advantageous effect on the immune system, which we think is the first study in the literature.
The study involved patients from a high-volume center for 32 months. The patients were allocated into three groups: patients with robotic (1), laparoscopic (2), and open surgery (3). Venous blood was derived on the postoperative 24th hour. The systemic immune-inflammation index scores were compared in three groups in terms of Group 1 vs. Groups 2 and 3, Groups 1 and 2 vs. Group 3, and compared with platelet-lymphocyte ratio, neutrophil-lymphocyte ratio scores.
Robotic surgery was performed in 55 patients, laparoscopic surgery in 13 patients, and open surgery in 248 patients. In the comparison of minimally invasive surgery (Groups 1+2) vs. open surgery (Group 3), systemic immune-inflammation index, platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio were found to be significantly lower in the minimally invasive surgery group (p<0.05). The comparison between robotic surgery patients (Group 1) and patients with laparoscopy/open surgery (groups 2 and 3) showed that systemic immune-inflammation index, platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio were significantly lower in Group 1 (p<0.05). neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammation index values were analyzed by receiver operating characteristic curve test, and the area under curve value of systemic immune-inflammation index was found to be higher in minimally invasive surgery group (robotic+laparoscopic) (p<0.05).
The study reveals the superiority of robotic gastrectomy as a more feasible and high-quality procedure over conventional techniques in terms of better preservation of immune system function using a reliable and noninvasive serum biomarker.
由于传统开放手术存在身体和代谢方面的并发症，机器人手术已受到关注。全身免疫炎症指数已成为一种最新且更可靠的生物标志物。在我们的单中心回顾性队列研究中，我们调查机器人胃癌根治术中的全身免疫炎症指数，以显示其对免疫系统的有益影响，我们认为这是文献中的首例研究。
该研究纳入了来自一个高容量中心的患者，为期32个月。患者被分为三组：机器人手术组（1组）、腹腔镜手术组（2组）和开放手术组（3组）。术后第24小时采集静脉血。比较三组的全身免疫炎症指数评分，包括1组与2组和3组比较、1组和2组与3组比较，并与血小板淋巴细胞比值、中性粒细胞淋巴细胞比值评分进行比较。
55例患者接受机器人手术，13例患者接受腹腔镜手术，248例患者接受开放手术。在微创手术（1组+2组）与开放手术（3组）的比较中，发现微创手术组的全身免疫炎症指数、血小板淋巴细胞比值和中性粒细胞淋巴细胞比值显著更低（p<0.05）。机器人手术患者（1组）与腹腔镜/开放手术患者（2组和3组）的比较显示，1组的全身免疫炎症指数、血小板淋巴细胞比值和中性粒细胞淋巴细胞比值显著更低（p<0.05）。通过受试者工作特征曲线测试分析中性粒细胞淋巴细胞比值、血小板淋巴细胞比值和全身免疫炎症指数值，发现微创手术组（机器人手术+腹腔镜手术）的全身免疫炎症指数曲线下面积值更高（p<0.05）。
该研究揭示了机器人胃癌根治术作为一种更可行、高质量的手术，在使用可靠且无创的血清生物标志物更好地保留免疫系统功能方面优于传统技术。
