Abstract: Objective:To explore the clinical efficacy of Da Vinci robotassisted radical gastrectomy for gastric cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 472 patients who underwent radical gastrectomy for gastric cancer in the 940 Hospital of the People′s Liberation Joint Service from June 2016 to June 2018 were collected. There were 372 males and 100 females, aged (57±11)years, with a range from 17 to 85 years. Patients underwent gastrointestinal angiography, magnetic resonance imaging, computed tomography or gastrointestinal endoscopy before surgery, and were diagnosed with gastric cancer by biopsy. Of the 472 patients, 241 underwent Da Vinci robotassisted radical gastrectomy for gastric cancer were allocated into robotic group and 231 underwent laparoscopyassisted radical gastrectomy were allocated into laparoscopic group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) followup and survival. Followup using outpatient examination and telephone interview was performed to detect the tumor recurrence and metastasis and survival of patients up to January 30, 2019. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were described as M (range). Count data were described as absolute number or percentage, and the chisquare test was used for comparison between groups. Comparison of ordinal data was done using the ranksum test. The accumulative survival rate, tumorbearing survival rate and mortality of tumor recurrence were calculated by the KaplanMeier method, and Logrank test was used for survival analysis.
Results: (1) Surgical situations: 472 patients underwent successful operation, with R₀ margin. Cases with total gastrectomy + D₂ lymph node dissection + Roux-en-Y anastomosis, cases with distal subtotal gastrectomy + D₂ lymph node dissection + Billroth Ⅱ anastomosis, operation time, upper margin distance, lower margin distance, tumor diameter, cases with shallow muscular invasion, deep muscular invasion, subserosal invasion and serosal invasion (depth of tumor invasion)were 107, 134, (234±44)minutes, (4±3)cm, (6±4)cm, (5 ±3)cm, 8, 17, 32, 184 in the robotic group, and 94, 137, (239±46)minutes, (4±3)cm, (6±4) cm, (5±3)cm, 7, 19, 30,175 in the laparoscopic group,respectively; there was no significant difference in above indicators between the two groups (X²=0.200, 2.459, t=-1.212,-1.074,-0.420,-1.236, Z=0.171, P>0.05). The volume of intraoperative blood loss, number of lymph nodes dissected in total gastrectomy, number of lymph nodes dissected in distal subtotal gastrectomy were (126±113)mL, 45±14, and 36±18 in the robotic group, and (149±132) mL, 39±14, 30±16 in the laparoscopic group, showing statistically significant differences between the two groups (t=-2.093, 3.275, 2.195, P<0.05). (2) Postoperative situations: the time to recovery of gastrointestinal function, time of postoperative abdominal drainage tube removal, and hospitalization cost in the robotic group were (2.6± 0.6)days, (5.7±1.2)days, and (100 157±44 888)yuan, respectively. The above indices of the laparoscopic group were (3.1±0.7)days, (7.0±3.0)days, and (82 220±18 941)yuan, respectively. There were statistically significant differences between the two groups (t=-5.371,-3.212, 5.603, P<0.05). The duration of postoperative hospital stay was (12±6)days in the robotic group and (12±6)days in the laparoscopic group, with no significant difference between the two groups (t=0.755, P>0.05). Eighteen out of 472 patients had complications. There were 3 cases of anastomotic leakage in the robotic group, 2 cases of gastroplegia, 1 case of duodenal stump, and 1 case of pulmonary infection, with a incidence of postoperative complication as 2.90% (7/241). There were 4 cases of anastomotic leakage in the laparoscopic group, 1 case of gastroplegia, 1 case of duodenal stump, and 3 cases of pulmonary infection, with a incidence of postoperative complication as 3.90% (9/231). There was no statistically significant difference in the incidence of postoperative complication between the two groups (X²=1.503, P>0.05). Patients with digestive tract fistula were reexplored and performed continuous flushingnegative pressure aspiration and nutritional support treatment, and then discharged after improvement. Patients with gastroplegia and lung infection were discharged after corresponding conservative treatment. (3) Followup and survival: 404 out of 472 patients were followed up for 7-31 months, with a median followup time of 19 months, including 212 in the robotic group and 192 in the laparoscopic group. The 3year survival rates were 96.70% and 91.67% in the robotic group and laparoscopic group, with no statistically significant difference between the two groups (X²=1.037, P>0.05). During the followup, the tumorbearing survival rate and mortality of tumor recurrence of the robotic group were 0.47% and 2.36%, respectively, versus 1.04% and 6.77% of the laparoscopic group, with statistically significant differences between the two groups (X²=3.198, 4.208, P<0.05).
Conclusion:The Da Vinci robotassisted radical gastrectomy for gastric cancer is safe and effective, which can reduce volume of intraoperative blood loss, shorten the postoperative recovery time, increase the number of lymph node dissection, however, it will increase the treatment expense.