Short-term outcomes of the Da Vinci Xi(fourth generation)robotic surgical system and laparoscopic-assisted gastrectomy for gastric cancer:a retrospective cohort study
Objective To compare and analyze the short-term efficacy of the Da Vinci Xi(fourth generation)robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method In this retrospective cohort study,clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May.The cohort comprised 136 men and 54 women aged 65(30-85)years.Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group.The remaining 100 patients had undergone laparoscopic-assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group.Variables investigated included surgical and postoperative factors and postoperative complications.Result The procedure was successfully completed without the need to transition to open surgery in every patient in both groups.The median duration of surgery was 315(270,360)minutes and 240(202,280)minutes,median intraoperative blood loss 20(10,30)mL and 30(10,50)mL,median incision length 12.0(10.8,13.0)cm and 10.0(8.0,10.8)cm,median time to first postoperative passage of flatus 4(3,5)days and 4(4,5)days,median time to first postoperative fluid intake 6(4,7)days and 8(6,9)days,time to gastric tube removal 4(3,7)days and 6(5,8)days,median time to drainage tube removal 8(7,10)days and 10(9,12)days,median duration of postoperative hospitalization 8(7,11)days and 12(10,14)days,and cost of surgery(7.6±1.2)×104 yuan and(4.0±0.6)×104 yuan in the robot-assisted and laparoscopic control groups,respectively.All the differences in the above indicators between the two groups of patients were statistically significant(all P＜0.05).There were also significantly fewer complications in the robot-assisted than the laparoscopic control group(28.9％[26/90]vs.44.0％[44/100],x2=0.31,P=0.031).Further subgroup analysis showed that the following factors were associated with greater improvement in the robot-assisted than laparoscopic control group:male sex(OR=0.41,95％CI:0.20-0.83,P=0.015),body mass index＜25 kg/m2(OR=0.41,95％CI:0.19-0.87,P=0.023),American Society of Anesthesiologists score 2-3(OR=0.14,95％CI:0.04-0.42,P=0.001),preoperative comorbidities(OR=0.29,95％CI:0.11-0.76,P=0.013),and stage Ⅰ-Ⅱ disease(OR=0.36,95％CI:0.13-0.91,P=0.035).Conclusion The Da Vinci robotic surgical system is safe and feasible for gastrectomy achieving a shorter recover period and fewer preoperative comorbidities.
Stomach neoplasmsRobotic-assisted surgery systemLaparoscopic gastrectomyClinical effectsComplication
万方数据
维普
