Nagata Hiromi, Kinoshita Takahiro, Komatsu Masaru, Habu Takumi, Yoshida Mitsumasa, Yura Masahiro
Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.
Course of Advanced Clinical Research on Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan.
Surg Endosc. 2025 Sep 13. doi: 10.1007/s00464-025-12171-9.
Robotic surgery for gastric cancer has been increasingly performed globally. The ability to perform accurate dissection is recognized as a pivotal advantage. As for reconstruction, the debate remains as to whether it should be partially extracorporeal or totally intracorporeal with robotic manipulation.
This retrospective study reviewed the clinical data of patients who underwent robotic radical gastrectomy with Roux-en-Y reconstruction (total gastrectomy or distal gastrectomy) for gastric cancer between January 2023 and October 2024. Patients were divided into two groups depending on how jejunal limb was created: extracorporeal via mini-laparotomy (Extra group, n = 50) or totally intracorporeal (Intra group, n = 58). Esophagojejunostomy in total gastrectomy or gastrojejunostomy in distal gastrectomy was done intracorporeally in all patients. Surgical outcomes were compared between the two groups.
The Intra group included more patients with high body mass index (BMI) (21.4 vs. 25.0 kg/m; P < 0.001). In the entire cohort, the Intra group showed shorter reconstruction times (56.5 vs. 69 min). Multiple regression analysis showed distal gastrectomy (t = - 4.492, P < 0.001) and the totally intracorporeal reconstruction (t = - 2.607, P = 0.011) were significantly associated with shorter reconstruction time. Reconstruction time in the Intra group was little affected by patient's BMI. No anastomosis-related complications were recognized in either group.
Totally intracorporeal Roux-en-Y reconstruction in robotic gastric cancer surgery may reduce reconstruction time because there is no need to undock the robotic system and there are no surgical interruptions. Furthermore, it has the advantage of not being affected by patient's BMI.
全球范围内，用于胃癌的机器人手术越来越多。能够进行精确解剖被认为是一个关键优势。至于重建，关于是应部分体外还是完全体内通过机器人操作进行，仍存在争议。
这项回顾性研究回顾了2023年1月至2024年10月期间接受机器人根治性胃切除术并采用Roux-en-Y重建（全胃切除术或远端胃切除术）治疗胃癌患者的临床资料。根据空肠袢的创建方式将患者分为两组：通过迷你剖腹术在体外创建（体外组，n = 50）或完全在体内创建（体内组，n = 58）。所有患者的全胃切除术中的食管空肠吻合术或远端胃切除术中的胃空肠吻合术均在体内进行。比较两组的手术结果。
体内组中体重指数（BMI）较高的患者更多（21.4 vs. 25.0 kg/m²；P < 0.001）。在整个队列中，体内组的重建时间更短（56.5 vs. 69分钟）。多元回归分析显示，远端胃切除术（t = -4.492，P < 0.001）和完全体内重建（t = -2.607，P = 0.011）与较短的重建时间显著相关。体内组的重建时间受患者BMI的影响较小。两组均未发现与吻合相关的并发症。
机器人胃癌手术中的完全体内Roux-en-Y重建可能会减少重建时间，因为无需拆卸机器人系统且无手术中断。此外，它具有不受患者BMI影响的优势。
