Analysis Of Short-term Efficacy Of Radically Robotic Total Gastrectomy For Gastric Cancer Based On Propensity Score Matching

Objective:To compare and analyze the short-term efficacy of radically robotic and laparoscopic total gastrectomy in patients with gastric cancer based on propensity score matching.And to investigate the safety,feasibility and potential advantages of radically robotic total gastrectomy for gastric cancer.Methods:A single-center retrospective case-control approach was used in this study.Data were collected from gastric cancer patients who underwent radically full robotic or full laparoscopic total gastrectomy in our hospital between June 2019 and January 2023.A total of 115 cases were included in this study,of which 55 gastric cancer patients who underwent radically full robotic total gastrectomy were divided into robotic total gastrectomy(RTG)group and 60 patients who underwent radically full laparoscopic total gastrectomy were divided into laparoscopic total gastrectomy(LTG)group.1.General data of patients were collected and analyzed,including age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)score,pTNM stage,maximum tumor diameter,and preoperative albumin.And 1:1 propensity score matching(PSM)was performed with them as matching variables.2.The intraoperative data of the two groups of patients after PSM were analyzed to compare the intraoperative outcomes of the two surgical approaches.The intraoperative data included intraoperative blood loss,number of lymph node dissection,condition of conversion to open surgery,total operation time,actual operation time,and docking time of robotic arms in the RTG group.3.The postoperative data of the two groups after PSM were analyzed to compare the short-term postoperative clinical outcomes of the two surgical approaches.The postoperative data included score of visual analogue scale(VAS score)on postoperative days 1 and 3,time to first flatus and time to first fluid intake after surgery,time to first get out of bed after surgery,amylase level of ascites on postoperative day 3,time to gastric tube removal and drainage tube removal after surgery,postoperative hospital stay,postoperative complications,total hospital cost.Results:A total of 72 patients with gastric cancer were included in the final study after PSM,including 36 patients in each of the RTG and LTG groups.1.General information:There was no significant difference between the general information of the two groups after PSM,and the dates were well-balanced(p>0.05).2.Intraoperative data:After PSM,intraoperative blood loss of the RTG group was less than that of the LTG group[145.00(135.00-163.75)vs 200.00(186.25-225.00)ml],the number of lymph nodes dissection was more than those in the LTG group[(34.75±6.62)vs(29.64±5.68),p<0.01],the total operation time[284.00(265.25-298.25)vs 238.00(229.75-254.75)min]and actual operation time[259.00(237.75-267.00)vs 238.00(229.75-254.75)min]were longer than those in the LTG group,and the differences were statistically significant(p<0.05).The rate of conversion to open surgery was similar in both groups,with no statistically significant difference(p>0.05).3.Postoperative data:After PSM,VAS scores on postoperative day 3 were lower in the RTG group than in the LTG group(p<0.01).The time to first flatus[45.50(42.0051.75)vs 51.50(44.25-60.00)hours],time to first getting out of bed after surgery[(47.53±9.27)vs(61.53±7.63)hours],time to drainage tube removal[9.00(8.50-9.50)vs 11.50(10.00-12.50)days],and postoperative hospital stay[13.00(12.13-13.38)vs 14.50(13.13-16.00)days]were significantly shorter in the RTG group than in the LTG group.Hospital costs of the RTG group were significantly higher than that of LTG group[93846.00(90537.00-95855.50)vs 68324.00(64571.25-69343.00)yuan,p<0.01].There were no statistically significant differences in VAS score on postoperative day 1,amylase level of ascites on postoperative day 3,time to first fluid intake and time to gastric tube removal between the RTG and LTG groups(p>0.05).There was no statistically significant difference between the two groups in the overall complication rate(p>0.05).Conclusion:The radically robotic total gastrectomy for gastric cancer is safe and feasible,and it has the advantages of less intraoperative trauma and less blood loss,more lymph nodes dissection,less postoperative pain for patients,faster recovery,and shorter hospital stay in comparison with radically laparoscopic total gastrectomy.The radically robotic total gastrectomy has a better short-term result.The operation time and hospital cost of radically robotic total gastrectomy still need to be improved.This study provides a basis for the application of robots in radical total gastrectomy for gastric cancer.