Wen-Jie Wang1, Rui Li2, Chang-An Guo3, Hong-Tao Li4, Jian-Ping Yu4, Jing Wang5, Zi-Peng Xu6, Wei-Kai Chen5, Zhi-Jian Ren2, Peng-Xian Tao2, Ya-Nan Zhang2, Chen Wang7, Hong-Bin Liu8. 1. Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China; Key Laboratory of Stem Cells and Gene Drugs of Gansu Province, Lanzhou, 730050, PR China. 2. Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China. 3. Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Key Laboratory of Stem Cells and Gene Drugs of Gansu Province, Lanzhou, 730050, PR China; Department of Emergency, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China. 4. Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China. 5. Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China; Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, PR China. 6. Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China. 7. Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, PR China. Electronic address: chenwang@lzu.edu.cn. 8. Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu, PR China; Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, PR China. Electronic address: liuhongbin999@163.com.
Abstract
BACKGROUND: Despite increasing evidence demonstrated robot-assisted distal gastrectomy (RADG) is safe and feasible for the treatment of advanced gastric cancer (AGC), robot-assisted total gastrectomy (RATG) remains a challenging procedure due to its technical difficulties and possible postoperative complications (POCs). This study aimed to systematically evaluate POCs following RATG. METHODS: Between January 2017 and January 2019, 319 AGC patients with pathological stage T2-4aN0-3M0 who underwent RADG or RATG were enrolled. POCs were stratified using the Clavien-Dindo classification. One-to-one propensity score matching was performed to reduce confounding differences. RESULTS: After matching, 266 patients met the criteria for further analysis. Ultimately, 64 patients (24.1%) who developed POCs had 126 clinical manifestation events. Overall the POCs rate was significantly greater after RATG in comparison with RADG (29.3% vs. 18.8%; P = 0.045), and more major POCs (Clavien-Dindo grade ≥ IIIa) were observed in the RATG group (14.3% vs. 5.3%; P = 0.013). The POCs were then classified into local and systemic POCs. The rates of local POCs (35.3% vs. 19.5%; P = 0.004) and systemic POCs (24.8% vs. 15.0%; P = 0.046) were significantly higher in the RATG group than the RADG group. Subgroup analysis showed that the anastomotic leakage rate was higher after RATG (5.3% vs. 0.8%; P = 0.031), whereas the remaining POCs were similar between the two groups. Patients with higher POCs significantly had longer postoperative length of stay (R = 0.895, P = 0.003). Multivariate analysis confirmed age, extent of resection, and TNM stage were risk factors for all POCs. CONCLUSIONS: These findings demonstrated that RATG is technically feasible and safe for treatment of AGC with acceptable morbidity and mortality rates. The POCs rate of RATG was higher than RADG, especially for anastomotic leakage. More effective anastomotic techniques are needed in RATG to prevent leakage.
BACKGROUND: Despite increasing evidence demonstrated robot-assisted distal gastrectomy (RADG) is safe and feasible for the treatment of advanced gastric cancer (AGC), robot-assisted total gastrectomy (RATG) remains a challenging procedure due to its technical difficulties and possible postoperative complications (POCs). This study aimed to systematically evaluate POCs following RATG. METHODS: Between January 2017 and January 2019, 319 AGC patients with pathological stage T2-4aN0-3M0 who underwent RADG or RATG were enrolled. POCs were stratified using the Clavien-Dindo classification. One-to-one propensity score matching was performed to reduce confounding differences. RESULTS: After matching, 266 patients met the criteria for further analysis. Ultimately, 64 patients (24.1%) who developed POCs had 126 clinical manifestation events. Overall the POCs rate was significantly greater after RATG in comparison with RADG (29.3% vs. 18.8%; P = 0.045), and more major POCs (Clavien-Dindo grade ≥ IIIa) were observed in the RATG group (14.3% vs. 5.3%; P = 0.013). The POCs were then classified into local and systemic POCs. The rates of local POCs (35.3% vs. 19.5%; P = 0.004) and systemic POCs (24.8% vs. 15.0%; P = 0.046) were significantly higher in the RATG group than the RADG group. Subgroup analysis showed that the anastomotic leakage rate was higher after RATG (5.3% vs. 0.8%; P = 0.031), whereas the remaining POCs were similar between the two groups. Patients with higher POCs significantly had longer postoperative length of stay (R = 0.895, P = 0.003). Multivariate analysis confirmed age, extent of resection, and TNM stage were risk factors for all POCs. CONCLUSIONS: These findings demonstrated that RATG is technically feasible and safe for treatment of AGC with acceptable morbidity and mortality rates. The POCs rate of RATG was higher than RADG, especially for anastomotic leakage. More effective anastomotic techniques are needed in RATG to prevent leakage.
Authors: J-J Tuech; A Gangloff; F Di Fiore; P Michel; C Brigand; K Slim; M Pocard; L Schwarz Journal: J Visc Surg Date: 2020-03-31 Impact factor: 2.043