| Objective:Gastric cancer is an important disease in the world.Incidence rate and mortality rate are high,which seriously threatens human health and life safety.With the significant improvement of living standards of Chinese residents,the number of people with high body mass index is increasing,and the number of patients with proximal gastric cancer accompanied by high body mass index is also gradually increasing.Total gastrectomy is still the main surgical method for the treatment of proximal gastric cancer.In the past,when total gastrectomy was performed in patients with high body mass index gastric cancer,the space was narrow and the operation was difficult,so it was often necessary to expand the incision or even laparotomy,which resulted in greater trauma and slow recovery.At present,minimally invasive technology is the development direction of gastric cancer surgery.After continuous in-depth research and development,Some minimally invasive surgical techniques such as laparoscopy,Da Vinci robot and hand-assisted 3D laparoscopy have been widely used in gastric cancer surgery.Because of some characteristics of hand-assisted 3D laparoscopy and Da Vinci robot,it has its unique advantages to operate in a narrow space,which is more suitable for people with high body mass index.Both of them have the same radical oncology effect as laparoscopy,but the cost of hand-assisted 3D laparoscopy is lower,which is more in line with the basic national conditions of our country.Therefore,this study will compare the safety,feasibility and clinical efficacy of hand-assisted 3D laparoscopic and robot-assisted laparoscopic radical total gastrectomy in patients with high body mass index gastric cancer,and explore the advantages and development prospects of hand-assisted 3D laparoscopic technology in high body mass index population.Methods:The clinical data of 44 patients with high body mass index gastric cancer who underwent surgery in the Department of General surgery of the first affiliated Hospital of Nanchang University from December 2016 to February 2020 were selected.according to the random number table method,the patients were divided into hand-assisted group(n = 22)and robot group(n = 22).Among them,those who received robot-assisted laparoscopic surgery were robot group,and those who received hand-assisted 3D laparoscopic surgery were hand-assisted group.The operation indexes,postoperative conditions and complications of the two groups were compared.The operation time,abdominal incision length,intraoperative blood loss,incidence of positive lymph nodes,total number of lymph node dissection,TNM stage,conversion rate to laparotomy were compared between the two groups;The postoperative recovery included the first exhaust time,the first liquid intake time,the incidence of postoperative complications,postoperative hospital stay,total hospital-lization time,total hospitalization expenses,reoperation rate,mortality and so on.All the clinical data and related data were recorded in the database.and all patients were followed up every 3 months by telephone or outpatient service.Follow-up lasted for15 months and 1-year overall survival rate was calculated.The primary endpoint event was death or the end of follow-up.The software SPSS25.0 was used for statistical analysis.The metrological data were expressed by mean ±standard deviation(x ±s),and t-test was carried out.X2 test was used to compare the counting data,P <0.05 showed that the difference was statistically significant.Results:The operations of all patients with high body mass index were completed successfully.The total cost of hospitalization in the hand-assisted group(61542±13313)was significantly lower than that in the robot group(70548 ±9667),The difference was statistically significant(P < 0.05);The length of abdominal incision in hand assisted group was(6.86 ±0.56)cm,slightly longer than the abdominal incision length of robot group(5.95 ±1.33)cm,the difference was statistically significant(P <0.05);The operation time of robot group was(207 ±30)min,the operation time of hand-assisted group was(224 ±30)min,there was no significant difference between the two groups(P > 0.05);the number of lymph node dissection of hand-assisted group was(29.91 ±10.20),and that of robot group was(30.59 ±17.07),there was no significant difference between the two groups;The intraoperative blood loss of hand-assisted group was(113±33)ml,and that of robot group was(106±25)ml,there was no significant difference between the two groups;and the first postopera-tive exhaust time was(3.14 ±0.48)days in the hand-assisted group and(3.09 ±0.29)days in the robot group,the difference was not statistically significant(P>0.05);The postoperative hospital stay was(10.09 ±6.38)days in the hand-assisted group and(8.68 ±1.64)days in the robot group,and the total hospital stay was(16.73 ±8.67)days in the hand-assisted group and(14.77 ±2.79)days in the robot group,and there was no significant difference between the two groups.The first fluid intake time was(4.15 ±0.49)days in the hand-assisted group and(4.09 ±0.29)days in the robot group.There was no significant difference between the two groups.There was no statistical significance in postoperative pathological stage,incidence of positive lymph nodes and postoperative chemotherapy rate;There were 3 cases of postoper-ative complications in hand-assisted group,including 1 case of esophagojejunostomy leakage,1 case of pulmonary infection and 1 case of abdominal infection.There was only one case of abdominal infection in robot group.There was no significant difference between the two groups.After 15 months of postoperative follow-up,the1-year overall survival rate in the hand-assisted group and the robot group was 95.5%and 86.4%,respectively,and the difference was not statistically significant.Conclusion:For patients with high body mass index undergoing radical total gastrectomy for gastric cancer,hand-assisted 3D laparoscopic radical total gastrectomy is a safe and feasible surgical method,which can achieve the same therapeutic effect as robot-assisted laparoscopic radical total gastrectomy.Compared with robot-assisted laparoscopy group,the learning curve is shorter,the hospitalization cost is significantly reduced,and the financial burden of patients is effectively reduced,which is worthy of further clinical research and promotion in primary hospitals. |
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