| Objective:Comparing the clinical outcomes between robotic and laparoscopic radical gastrectomy for distal advanced gastric cancer,in order to assess the efficacy and clinical application of robotic distal radical gastrectomy.Methods:The clinical data of patients undergoing robotic or laparoscopic gastric cancer surgery in the First Affiliated Hospital of Nanchang University from December 2016 to December 2018 were retrospectively analyzed.273 patients who underwent robotic or laparoscopic gastric cancer surgery were enrolled in this study,include 146 patients underwent robotic distal radical gastrectomy,and 127 patients underwent laparoscopic distal radical gasterctomy.Patients were divided into robot surgery group(RG group)and laparoscopic surgery group(LG group)according to the surgical way.The intraoperative and postoperative condition of RG group and LG group were compared and the results were used to assess the efficacy and clinical application of robotic surgical system for distal advanced gastric cancer.Results:There was no significant difference in the basic characteristics data such as gender,age,BMI between RG group and LG group.All surgeries of 273 patients were performed successfully without conversion to open surgery or death.In RG group,53 patients(36.3%)underwent total intra-abdominal anastomosis,and in LG group the number was 19(15.0%).Comparing with LG group the operation time of RG group was longer [(191.6±35.6)min vs.(181.9±38.7)min,P=0.032],but the blood loss during the surgery was less [(118.6±37.7)ml vs.(134.2±48.9)ml,P=0.003],the incision length was shorter [(6.1±1.4)cm vs.(6.6±1.7)cm,P=0.013],the postoperative pain in 24 hours was milder(c2=9.904,P<0.042),the The time to start working after surgery is earlier [(1.4±0.5)d vs.(1.7±0.6)d,P=0.002],the removal time of abdominal drainage is earlier [(8.0±2.5)d vs.(8.7±1.8)d,P=0.010],the hospital stay time isshorter [(8.8±3.5)d vs.(9.6±1.9)d,P=0.016].and the overall number of lymph nodes detected was more [(32.7±6.9)vs.(28.2±7.1),P<0.05].There were no statistically significant difference between the two groups among the way of digestive tract reconstruction,flatus time,time of resuming diet,gastric tube remove time,the largest diameter of the tumor,proximal and distal margin distance,pathological type of tumor,number of positive lymph nodes,number of lymph node positive patients,TNM stage.16 patients(11.0%)experienced postoperative complications in the robotic group,and 18 patients(14.2%)experienced postoperative complications in the laparoscopic group.There were no significant differences in postoperative complications between RG group and LG group,(P = 0.422).During a postoperative follow-up period of 13(range,1-27)months,7 patients(4.8%)were lost to follow-up in robot group,and 9 patients(7.1%)were lost to follow-up in laparoscopic group.In the robotic group,there were 14 patients(9.6%)with recurrence and metastasis,and 9 patients(6.2%)were died during the follow-up time.In laparoscopic group,16 patients(12.6%)experienced recurrence and metastasis,11 patients(8.76.3%)dired during the follow-up time.There was no statistically significant difference in the tumor-free survival curves(P=0.359)and the overall survival curves(P=0.442)between the two groups.Conclusion:Robotic radical gastrectomy for distal advanced gastric cancer is safe and feasible.Compared with the laparoscopic surgery system,the robotic surgery system has less intraoperative bleeding,more lymph node dissection,better recovery after surgery,and the sophisticated and flexible operating instruments make it easier to perform complex laparoscopic procedures.Robotic surgery system could be promoted for distal advanced gastric cancer,and has a good application prospect. |
PDF Full Text Request