Comparison Of Short-term Efficacy And Safety Between Total Robotic And Total 3D Laparoscopic Distal Radical Gastrectomy For Gastric Cancer In ERAS Mode

Objective:To investigate the short-term efficacy and safety of total robotic versus total 3D laparoscopic radical distal gastrectomy for gastric cancer under the management mode of Enhanced Recovery After Surgery(ERAS).Methods:A retrospective analysis was performed on patients who underwent total robotic and total 3D laparoscopic distal gastrectomy at the Third Surgery Department of the Fourth Hospital of Hebei Medical University between November 2019 and December 2020.A total of 298patients who under the management mode of ERAS were included in the study.The clinicopathological data of the patients were analyzed,62 patients who did not meet the inclusion criteria were excluded,and 236 patients were included for analysis,and among them 73 cases accepted total robotic in patients with distal gastric cancer radical divided into the Robot group,163 patients underwent total 3D laparoscopic distal gastric cancer radical patients divided into the Laparoscopy group.Baseline characteristics of patients in both groups were analyzed,including sex,age,body mass index(BMI),ECOG score,tumor diameter,Lauren classification,tumor differentiation degree,clinical and pathological stages.The propensity score was used for matching analysis according to 1:1,so that the baseline characteristic data of the two groups were basically the same(P>0.05),73 patients in the Robot group and 73patients in the Laparoscopy group were eventually included,among which 25patients in the Robot group had BMI≥25.0kg/m~2(34.25%),and 48 patients had BMI<25.0kg/m~2(65.75%),while in the Laparoscopy group,there were 26patients with BMI≥25.0kg/m~2(35.62%),47 patients with BMI<25.0kg/m~2(64.38%).Comparative analysis of two groups of patients with perioperative relevant information:bleeding volume during surgery,operative time,intraoperative preparation time,digestive tract reconstruction time,the number of lymph nodes retrieved,the rate of lymph node metastasis,postoperative activity time,postoperative pain score,postoperative time of gastric tube extraction,postoperative exhaust time,postoperative fluid intake time,postoperative hospital stay,the total incidence of postoperative complications and the hospitalization cost of the patients,etc.And at the same time with different BMI layered comparison analysis between the two subgroups.Results:The bleeding volume during surgery in the Robot group(30.21±13.78)ml was less than that in the Laparoscopy group(41.44±17.41)ml(P<0.001),and the intraoperative preparation time(31.05±4.93)min was longer than that of Laparoscopy group(15.48±2.43)min(P<0.001),the digestive tract reconstruction time(32.67±4.41)min was less than that of the Laparoscopy group(39.78±4.95)min(P<0.001),patients with postoperative activity time(14.07±8.97)than the Laparoscopy group earlier(17.49±5.98)(P=0.007),the postoperative exhaust time(1.78±0.79)d was shorter than that of the Laparoscopy group(2.18±0.79)d(P=0.003),the postoperative time of gastric tube extraction(2.44±0.91)d was earlier than that of the Laparoscopy group(P=0.033),and the postoperative hospitalization time(7.74±3.15)d was shorter than that of the Laparoscopy group(9.97±3.23)d(P<0.001),and the postoperative pain score of the Robot group was lower(P=0.006),but the hospitalization cost of the Robot group(125615.82±11900.80)yuan was higher than that of the Laparoscopy group(89907.15±17147.19)yuan(P<0.001),and there were no significant differences between the two groups in operative time,the number of lymph nodes retrieved,the rate of lymph node metastasis,postoperative fluid feeding time and the total incidence of postoperative complications(P>0.05).When BMI≥25.0kg/m~2,the main advantages of the Robot group compared with the Laparoscopy group were lower intraoperative blood loss[Robot group(30.20±11.68)ml vs.Laparoscopy group(50.00±19.70)ml;P<0.0 01],shorter reconstruction time of digestive tract[Robot group(33.00±4.45)min vs.Laparoscopy group(41.73±3.89)min;P<0.001],lighter postoperative pain score(P=0.004).The postoperative activity of getting out of bed was earlier[Robot group(14.04±7.13)h vs.Laparoscopy group(18.38±6.52)h;P=0.028].When BMI<25.0kg/m~2,the Robot group had less intraoperative blood loss[Robot group(30.21±14.87)ml vs.Laparoscopy group(36.70±14.11)ml;P=0.032],the reconstruction time of digestive tract was shorter[Robot group(32.50±4.42)min vs.Laparoscopy(38.70±5.18)min;P<0.001],and postoperative exhaust was earlier[Robot group(1.77±0.75)d vs.Laparoscopy group(2.19±0.80)d;P=0.010].Postoperative hospital stay was shorter[Robot group(7.44±2.05)d vs.Laparoscopy group(9.77±2.55)d;P<0.001],but operative time was longer[Robot group(232.17±42.74)min vs.Laparoscopy group(214.53±31.17)min;P=0.024].Intraoperative preparation time was longer in the robot group regardless of whether BMI was higher than 25.0(P<0.05),the hospitalization cost was higher(P<0.05),and no significant differences were observed in the comparison of other perioperative indicators(P>0.05).Conclusions:Both robotic and 3D laparoscopic radical resection of distal gastric cancer under ERAS mode are safe and feasible.Compared with3D laparoscopy,robot has better intraoperative bleeding control effect and greater advantages in digestive tract reconstruction.And robot also has certain advantages in the postoperative recovery process of patients.