AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBAS...AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.展开更多
文摘AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.
文摘目的:随着微创外科技术的发展,达芬奇机器人技术的应用越来越广泛。本研究通过分析机器人辅助胃切除术(robotic-assisted gastrectomy,RAG)与腹腔镜辅助胃切除术(laparoscopic-assisted gastrectomy,LAG)2种不同外科技术初期阶段学习曲线的比较,探讨先进手术机器人技术对外科手术学习曲线的可能影响。方法:选取在2017年9月至2020年12月一名主刀医师从初始阶段开始实施RAG或LAG手术的远端胃癌根治术的108例患者,分为行达芬奇Si机器人系统RAG的RAG组(n=27)和行LAG的LAG组(n=81),胃癌区域淋巴结分组参照日本胃癌治疗指南实施,分析其围手术期结果、术后并发症、术后肿瘤学结果和外科手术学习曲线等相关情况。结果:2组患者在一般资料、肿瘤大小、组织学分级和临床分期上的差异均无统计学意义(均P>0.05);RAG组术后严重并发症的发生率低于LAG组(P=0.003);RAG组术中的失血量低于LAG组的失血量(P=0.046);RAG组清扫淋巴结数量更多(P=0.003),其中在第9组(P=0.038)和11p组(P=0.015)淋巴结清扫中表现出明显优势;RAG组手术时间明显比LAG组长(P=0.015);学习曲线分析发现,RAG组的累积和分析(cumulative sum analysis,CUSUM)值从第10例开始下降,而LAG组的CUSUM值从第28例开始下降,RAG的学习曲线比LAG的学习曲线具有更少的截止案例。手术机器人的独特设计可能有助于提高手术效率和缩短外科手术学习曲线。结论:先进机器人技术有助于经验丰富的外科医生快速学习掌握RAG技能,超越机器人学习曲线达到熟练阶段需要的最少手术例数为10例,并在第9组和11p组淋巴结清扫和减轻手术创伤方面优于LAG。RAG手术比LAG手术能清扫出更多的淋巴结,有更好的围手术期疗效。
