| Background Gastric cancer is one of the most common digestive tract cancers in the world, and the major treatment for it is still surgery. However, serious surgical trauma is inevitable in the conventional open surgery. Since nearly 20 years of continuous exploration and innovation, the use of laparoscopic-assisted gastrectomy (LAG) has become widely accepted in the field of gastric cancer. Many studies have reported that LAG is beneficial in terms of postoperative pain, hospital stay, recovery, and return to normal activity. However, LAG also has some technical limitations of restricted ranges of instrument movement,2-dimensional visualization, hand tremor amplification, and the uncomfortable position forced upon surgeons, and thus, this procedure impeded the applications of laparoscopy in some complex surgery. LAG has two diffculties in the field of gastric cancer:precise D2-lymph node dissection and full-endoscopic reconstruction of alimentary tract. These skills are hard to master because of the limitations of laparoscopy. In order to minimize the difficulty of laparoscopy, a robotic surgery system was introduced. Robotic surgery is advanced to conventional laparoscopic surgery in that it has a tremor filter, can scale motions, has 3-D imaging, and provides improved dexterity with articulated EndoWrist that allows seven degrees of freedom. These characteristics are extremely important when precise lymph node dissection and full-endoscopic reconstruction of alimentary tract are required for gastric cancer.Objective To compare the short-term clinical outcomes of laparoscopic and full da Vince robotic total gastrectomy for gastric cancer and evaluate the safety and feasibility of robotic system.Method Date of gastric cancer patients who undergoing full robotic total gastrectomy (RTG) and laparoscopic-assisted total gastrectomy (LATG) in our department from February 2012 to February 2014 were retrospectively analyzed. Reconstruction of the alimentary tract was achieved using extracorporeal method through a minilaparotomy in LATG group, and intracorporeal robot-sewn anastomosis in RTG group. We performed a comparative analysis between the RTG group and LATG group for intraoperative factors(conversion, blood loss, operative time, incision length), oncologic outcomes(TMN stage, lymph node dissection, margin) and postoperative indicators(VAS pain scores, hospital stay, hospital costs complications, mortality).Result Totally,124 cases were included in this study, including 58 cases in the RTG group and 66 cases in the LATG group. There were no significant differences between these two groups with respect to age, sex, BMI, TNM stage, the number of dissected lymph nodes, proximal and distal resection margins complications, and mortality. All the operations were performed successfully with no conversions. The mean blood loss was less in the RTG group than the LATG group[(60±16) VS (98 ±17)] ml, the mean operative time in the RTG group was longer[(237±46) VS (178±52)]min, the incision length in the RTG group was shorter[(4.2±1.7) VS (8.9±2.6)]cm, the RAG group’s VAS pain scores was lower in the three days after surgery, and the postoperative hospital stay in the RTG group was shorter[(5.3±2.6) VS (6.1±3.1)] d, the costs in the RTG group was much higher[(65320±1214) VS (51502±1465)]CNY.Conclusions Robotic total gastrectomy is safe and feasible for gastric cancer,RTG group has better short-term compared with LATG group in terms of blood loss, incision length,postoperative pain,and hospital stay, and is advantageous in terms of alimentary tract reconstruction and lymph node dissection. |
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