The Study On Clinical Outcomes Of Robotic Gastrectomy Combined With Enhanced Recovery After Surgery Programs

Part ?The Study on Long-term Survival of Robotic Gastrectomy Combined with Enhanced Recovery after Surgery Programs Aim:Prior studies showed that for patients with gastric cancer,robotic gastrectomy(RG)and enhanced recovery after surgery(ERAS)programs achieved satisfied short-term outcomes and improved the medical quality perioperatively.However,data on long-term survival of patients received RG and ERAS programs have not be reported.This study was to explore long-term survival after RG and ERAS programs.Methods:From July 2010 to June 2018,five hundred and seventy-six patients who underwent RG and ERAS programs in our center were evaluated retrospectively.Short-term outcomes,long-term survival and factors affecting long-term survival were analyzed.Results:The mean age was 58.8±10.5 years old,and 431 patients were male(74.3%).The mortality was 0.7%and the incidence of postoperative complications was 12.1%.The median postoperative length of stay was 5 days(interquartile range:4-7 days).For the entire cohort,3-year overall survival(OS)and relapse-free survival(RFS)rates were 85.8%(95%CI 82.3-88.6)and 81.9%(95%CI 78.1-85.0)respectively;5-year OS and RFS rates were 79.2%(95%CI 74.8-82.9)and 76.3%(95%CI 71.9-80.1),respectively.For patients with stage ?,3-year OS and RFS rates were 96.9%(95%CI 93.3-98.6)and 96.1%(95%CI 92.3-98.0);5-year OS and RFS rates were 95.2%(95%CI 90.4-97.7)and 94.3%(95%CI 89.5-97.0),respectively.For patients with stage ?,3-year OS and RFS rates were 84.3%(95%CI 76.1-89.9)and 81.2%(95%CI 72.7-87.3);5-year OS and RFS rates were 72.6%(95%CI 61.6-81.0)and 70.9%(95%CI 60.0-79.4),respectively.For patients with stage ?,3-year OS and RFS rates were 75.6%(95%CI 68.6-81.3)and 68.5%(95%CI 61.3-74.6);5-year OS and RFS rates were 68.0%(95%CI 60.1-74.6)and 62.6%(95%CI 54.9-69.4),respectively.Cox regression analysis showed that pTNM staging(OS:? vs.?,HR 7.347,95%CI 3.341-16.157,P<0.0001;? vs.?,HR 9.609,95%CI 4.576-20.178,P<0.0001;RFS:? vs.I,HR 6.494,95%CI 3.179-13.268,P<0.0001;? vs.?,HR 9.332,95%CI 4.802-18.136,P<0.0001)and complications(OS:HR 3.914,95%CI 2.430-6.304,P<0.0001;RFS:HR 3.925,95%CI 2.542-6.060,P<0.0001)were independent risk factors for OS and RFS rates.Conclusion:Based on this study and several similar studies in other centers,it is safe and feasible to apply RG and ERAS programs in patients with gastric cancer due to acceptable short-term outcomes and long-term survival.The pTNM stage and complications are independent risk factors for OS and RFS rates.Early screening and early diagnosis will be effective measures to improve long-term survival of gastric cancer.Reducing postoperative complications will be the direction of ERAS.Part ?Patients Administered Neoadjuvant Chemotherapy Could be Enrolled into an Enhanced Recovery after Surgery Programs for Locally Advanced Gastric CancerAim:Most studies on enhanced recovery after surgery for gastric cancer exclude patients who received neoadjuvant chemotherapy.Here,we aimed to evaluate whether patients who received neoadjuvant chemotherapy can be enrolled into the ERAS program for locally advanced gastric cancer.Methods:From April 2015 to July 2017,114 patients who received neoadjuvant chemotherapy for locally advanced gastric cancer were randomized into ERAS and standard care(SC)groups.Postoperative length of stay,complications,bowel function,and nutritional status were recorded.Results:The postoperative length of stay of the ERAS group was shorter compared with that of the SC group(5.9 ± 5.6 vs.8.1 ± 5.3 days,P=0.037).The postoperative complication rate was 9.3%in the ERAS group and 11.5%in the SC group(P=0.700).The time to first flatus(2.7 ±2.0 vs.4.5± 4.6 days,P=0.010)and time to a semi-liquid diet(3.2 ± 2.1 vs.6.3± 4.9 days,P<0.001)in the ERAS group were shorter compared with those in the SC group.On the 10th day after surgery,the losses of weight,total protein,albumin,and prealbumin of the ERAS group were lower compared with those of the SC group.Conclusions:Patients who received neoadjuvant chemotherapy could be enrolled into ERAS programs for locally advanced gastric cancer.The nutritional status of these patients was not adversely affected.Part?Safety of Discharge Within 72 Hours of Robotic Gastrectomy Using Enhanced Recovery After Surgery ProgramsAim:To evaluate the safety and outcome of discharge within 72 hours of a robotic gastrectomy together with enhanced recovery after surgery programs.Methods:In total,108 consecutive patients received elective robotic gastrectomy for gastric cancer from April 2017 to September 2017.All patients attended ERAS programs,which do not routinely use nasogastric tubes but include early feeding,early ambulation,and standard discharge criteria,among other items.Results:The mean age was 58.7±10.4 years old,and the mean body mass index was 22.9±2.8 kg/m2.The mean postoperative length of hospital stay was 5.6±8.0 days,and 13 patients(12.0%)exhibited a complication within 30 days with no mortality.A total of 38 patients(35.2%)were discharged within 72 hours of surgery.Patients were grouped based on being discharged within or after 72 hours.The rate of complications was significantly lower in patients discharged within 72 hours than patients discharged after 72 hours(1/38,2.6%vs.12/70,17.1%,P=0.028).Although patients discharged within 72 hours showed lower readmission,this difference was not statistically significant(1/38,2.6%vs.8/70,11.4%,P=0.116).One month after surgery,loss of weight,loss of total protein,loss of albumin,and loss of prealbumin in patients discharged within 72 hours were less than those of patients discharged after 72 hours.Conclusion:Under the standard ERAS programs and discharge criteria,it is safe to discharge within 72 hours of robotic gastrectomy electively.Complication and readmission rates are low in patients discharged within 72 hours of robotic gastrectomy when ERAS programs and standard discharge criteria are used.