Robotic Gastrectomy Short-term Surgical Outcomes Versus Laparoscopic And Open Gastrectomy: A Case-control Study

BackgroundGeriatric cancer is one kind of malignant tumor which is common in our country andaround the world with a death rate of more than40%.Every year, there are two hundredthousand newly emerging gastric cancer patients which has the first rank for17.2%.It isserious for human health. Now, surgical resection is still the only way to cure this disease.Since Japanese author Kitano report the first laparoscopic gastrectomy, comparing with opengastrectomy, Laparoscopic gastrectomy has been widely used as it has less trauma and lessrecovering time. Studies in recent years have demonstrated that laparoscopic gastrectomy cannot only completely resect the primary lesion, but also conduct the dissection of gastriclymph node. Its short-term efficacy is superior to open surgery while the long-term efficacy isconsiderable to open surgery.The invention of Da vinci robotic surgery system creates a new area of minimallyinvasive surgery with the development of minimally invasive surgery. The system uses amaster-slave operating system which consists of three parts including a physician consoledesk, imaging system and the bedside surgical instruments arm system. The surgeon can useremote control console to operate the three simulated arm through the laparoscopic interfaceto conduct the laparoscopic gastrectomy. Comparing to the classic laparoscopicgastrectomy,Davin ci robotic surgery system has the ability to chip the wave of hands, createthe proportion of movement.Morever, this system has3D imaging capabilities and higherresolution which can make the room much clearer. This three simulated arm has seven freemovement directions which can make the operation more stable, more accurate andsafer.However, as a new technology, the feasibility,safety and the prognosis of the patientsneed evaluation.ObjectAfter retrospectively analyzing the clinical data of patients who had gastrectomies from March2010to March2012in the Southwest Hospital,we matched the patients with thenearest available scores such as age, sex, BMI and cancer stage. After that, we evaluate theoperation index and postoperative index to analysis the feasibility and safety of the roboticgastrectomy.MethodWe retrospectively analysis the clinical data of48patients who had underwent roboticgastrectomies from March2010to March2012in the Southwest Hospital,48patients withlaparoscopic gastrectomy and48patients with open gastrectomy were matched with thenearest available scores such as age, sex, BMI and cancer stage. We chose the way ofoperation according to the location of the tumor.All the patients were treated with theJapanese13rd D2gastrectomy to dissect the lymph nodes. Using the mean operation time,blood loss, the number of the lymph nodes, the near cutting edge length, the long cutting edgelength, the first postoperative flatter day, postoperative liquid diet time, postoperative rate ofcomplications and postoperative hospital stay time as index to evaluate the three groups.Then we analysis the date using the SPSS19.0. Student’s t-test for continuous variables andthe chi-square test for categorical variables. For both tests, P values less than0.05wereinterpreted as statistically significant. Values are expressed a mean±standard deviation.Results48patients underwent laparoscopic gastrectomy and48patients underwent opengastrectomy were matched with the robotic group using the nearest neighborhood matching.There are no significant differences among the three groups in age, sex, BMI and stage oftumor. Comparing to the laparoscopic group, the robotic group has less bloodloss(P=0.041),longer operation time(P=0.011), higher number of dissected lymphnodes(P=0.026). There are no significant differences between the two groups in the nearcutting edge length, the long cutting edge length,the first postoperative flatter day,postoperative liquid diet time, postoperative rate of complications and postoperative hospitalstay time. Compared to the open group, the robotic group has less blood loss(P<0.001),longer operation time(P=0.016), higher number of dissected lymph nodes(P=0.016), earlierday of first flatter(P=0.016), shorter time of liquid diet and postoperative hospital stay.ConclusionThe Davin ci surgery system is safe and feasible for gastrectomy. Compared with the classic laparoscopic gastrectomy, the robotic system makes less trauma and has a highernumber of dissected lymph nodes. Compared with the open gastrectomy, the robotic systemmake less blood loss, more lymph node dissection and more quickly recovering.