Abstract: Objective:To compare the short-term clinical effects of Da Vinci robotic surgical system-assisted and laparoscopy-assisted operations for gastrointestinal stromal tumor (GIST).
Methods:The retrospective cohort study was conducted. The clinical data of 98 patients with GIST who were admitted to the Lanzhou General Hospital of Chinese People′s Liberation Army from June 2016 to May 2018 were collected. Of 98 patients, 45 undergoing Da Vinci robotic surgical system-assisted surgery for GIST and 53 undergoing laparoscopy-assisted surgery for GIST were respectively allocated into the robotic group and laparoscopic group. The associate senior and above doctors performed the surgery. The wedge resection was applied to patients with diameter of gastric stromal tumor < 5 cm, and subtotal gastrectomy + digestive tract reconstruction (gastrojejunostomy and Brauns anastomosis)were applied to patients with diameter of gastric stromal tumor > 5 cm or tumor located in the cardia and pylorus. Patients with intestinal stromal tumor underwent intestinal resection + end-to-side anastomosis. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to July 2018.Measurement data with normal distribution were represented as ±s, and comparison between groups was done using the independentsample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using nonparametric test. Comparisons of count data were analyzed using chisquare test.
Results:(1) Surgical and postoperative situations: 98 patients underwent successful surgery. The operation time, volume of intraoperative blood loss, recovery time of gastrointestinal function, time of gastrointestinal decompression tube removal, time of abdominal drainage tube removal and duration of postoperative hospital stay were respectively (152±49)minutes, 100 mL (range, 10-300 mL), (2.6±0.6)days, (1.1± 0.3)days, (5.7±1.2)days, (8.3±1.3)days in the robotic group and (201±62)minutes, 100 mL (range, 5- 600 mL), (3.1±0.7)days, (2.1±1.5)days, (6.9±3.4)days, (11.6±7.0)days in the laparoscopic group, with statistically significant difference between groups (t=-3.983, Z=2.104, t=-3.776,-3.637,-2.018, -2.817, P<0.05). (2) follow-up: 98 patients were followed up for 2-24 months, with a median time of 13 months. During the follow-up, there was no tumor recurrence or metastasis between groups.
Conclusion:Compared with laparoscopy-assisted surgery, Da Vinci robotic surgical system-assisted surgery for GIST is safe and feasible, with advantages of shorter operation time, faster postoperative recovery and shorter duration of hospital stay.