Safety,Feasibility And Recent Clinical Efficacy Of Robotic Surgery Combined With IORT In The Treatment Of Progressive Gastric Cancer

Objective:This study compares the recent clinical efficacy of robotic surgery combined with intraoperative radiotherapy(IORT)compared with robotic surgery alone for locally progressive gastric cancer in patients diagnosed with progressive gastric cancer at the General Surgery Clinical Centre of Gansu Provincial People’s Hospital between October2020 and September 2022.This study was conducted to evaluate the safety,efficacy and feasibility of IORT,and to investigate the recent clinical efficacy of this technique in patients with locally progressive gastric cancer,in order to provide further scientific basis for the clinical practice of gastrointestinal surgeons.Methods :According to the inclusion and exclusion criteria,the clinical data of 42 patients diagnosed with gastric cancer with parallel robotic surgery and IORT from October2020 to September 2022 in the Department of General Surgery of Gansu Provincial People’s Hospital were included,including the IORT group(21 patients)and the control group(21 patients),Baseline data for both groups of patients,intraoperative and postoperative statistics,complications,haematological indicators,postoperative pathological results,costs and follow-up results of the two groups were statistically analysed.Results :(1)According to the inclusion and exclusion criteria,a total of 21 patients were included in the IORT group,with a mean age of(62.76±9.81)years,19.1% were male,and 100% of the patients with stage T4 tumours,4 patients were treated with preoperative conversion,2 of them based on oxaliplatin+capecitabine regimen,2 with a single metastatic nodule in the liver,preoperatively given oxaliplatin+calcium folinic acid+ The patients had one case of preoperative hypoproteinemia,one case of reflux oesophagitis and one case of hypertension and diabetes mellitus.21 patients were included in the control group,with a mean age of(62.14±9.16)years,9.5% were male,and the tumours were mainly stage T3 patients without distant metastases and preoperative conversion therapy.The statistical analysis of the baseline data and tumour-related characteristics of the two groups showed no difference(P > 0.05).(2)In the IORT group,total gastrectomy and distal gastrectomy were performed in 15(71.4%)and 6(29.6%)patients respectively,and Roux-en-Y anastomosis and Bi-II anastomosis were performed in 17(80.9%)and 4(19.1%)patients respectively.The time to deflation was slightly longer in the IORT group than in the control group [(52.45±9.61)h vs.0.304,P=0.763)];time to bed activity was slightly longer in the IORT group than in the control group [(36.62±4.73)h vs.d,(t=-0.190,P=0.851)];longer operative time in the IORT group than in the control group [(252.00±46.25)min vs.(238.33±44.37)min(t=0.977,P=0.334)],and greater intraoperative blood loss in the IORT group than in the control group [(131.91±129.33)m L vs.(107.14±93.92)m L(t=0.710,P=0.482)];the IORT group was inferior to the control group in all of the above indicators,but the differences were not statistically significant(P >0.05);(3)the number of positive lymph nodes in the IORT group was significantly higher than that in the control group [(13.14±8.50)vs.The total number of lymph nodes cleared and the distance between the proximal and distal margins from the tumour were not statistically different(P > 0.05);(4)3 patients in the IORT group and3 patients in the control group each had postoperative complications(14.3%),but the difference was not statistically significant.One patient in the IORT group with anastomotic leak was cured after drainage,parenteral nutrition and symptomatic treatment;one patient in the IORT group and two patients in the control group with abdominal infection were cured after abdominal puncture and drainage and anti-infection treatment;one patient in the IORT group and one patient in the control group with gastric insufficiency were cured after parenteral nutrition,gastric motivation and acupuncture treatment.(5)The NEUT%(neutrophil percentage)on the third day after surgery was slightly higher in the IORT group than in the control group;the results were statistically significant(P < 0.05),while the rest of the preoperative blood indicators were not different between the two groups(P > 0.05).0.05).(6)The average follow-up of the 21 patients in the IORT group was 9.8 months;the average follow-up of the 21 patients in the control group was 10.2 months.One patient in the control group had tumour recurrence 14 months after surgery and one patient in the IORT group died 5 m(1)da Vinci robotic radical gastric cancer treatment combined with intraoperative radiotherapy(IORT)is safe and feasible for the treatment of progressive gastric cancer,with good shortterm clinical efficacy;(2)compared with conventional robotic gastric cancer surgery,the operation time,intraoperative bleeding,hospitalization cost and postoperative response of da Vinci robotic radical gastric cancer treatment combined with IORT are slightly longer,but not statistically significant,while da Vinci robotic gastric cancer treatment combined with IORT is more in line with the current individualized treatment of precision medicine.(3)The da Vinci robotic radical gastric cancer treatment combined with IORT did not increase the risk of postoperative complications and there were no statistically significant differences in the postoperative outcomes of patients in terms of tumour implantation,recurrence and metastasis compared to conventional robotic surgery.