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Chen J, Wang F, Wang Y, Zhou J, Yang Y, Zhao Z, Wu R, Wang L, Ren J. A comparison of postoperative outcomes between robotic-assisted and laparoscopic-assisted total gastrectomy: a comprehensive meta-analysis and systematic review. BMC Surg 2025; 25:212. [PMID: 40375289 PMCID: PMC12079958 DOI: 10.1186/s12893-025-02934-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 04/24/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND The application of robot-assisted technology in gastric cancer surgery is gradually gaining attention from surgeons. In this meta-analysis, our main objective was to assess whether robot-assisted techniques are more advantageous than laparoscopic-assisted technology in total gastrectomy. METHODS We searched Pubmed, Embase, Web of Science, and Cochrane Library databases for clinical studies published before October 2023 comparing robotic-assisted total gastrectomy (RATG) and laparoscopic-assisted total gastrectomy (LATG) for gastric cancer. Non-clinical studies, data unavailability, or fewer than 50 included cases were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias by determining the quality of the observational studies. Statistical meta-analysis and drawing were performed using the Software Review Manager version 5.3 and Stata version 16.0. P < 0.05 was considered significant. RESULTS Nine studies that included 1,864 patients with gastric cancer were included, published between 2012 and 2023. The results of the analysis showed that RATG has advantages in the following aspects: intraoperative blood loss was 17.69 ml lower in the RATG group than in the LATG group (WMD: -17.69,95% CI:-20.90 ∼ -14.49; P < 0.05); In terms of the number of resected lymph nodes, the RATG group had 2.65 more than the LATG group (WMD: 2.65,95% CI:0.88 ∼ -4.42); P < 0.05); the time to start liquid and postoperative hospital stays were 0.62 and 0.90 days shorter in the RATG group than in the LATG group, respectively (WMD: -0.62,95%CI: -1.06 ∼ -0.19; P < 0.05), (WMD: -0.90,95%CI: -1.43 ∼ -0.37; P < 0.05)); the incidence of major complications and pancreas fistula in the RATG group was 0.59% and 0.17% lower than in the LATG group, respectively (OR: 0.59,95% CI: 0.38 ∼ 0.93; P < 0.05), (OR: 0.17,95% CI: 0.03 ∼ 0.94; P < 0.05). However, the analysis showed that the operative time in the RATG group was 30.96 min longer than in the LATG group (WMD: 30.96,95% CI: 21.24 ∼ 40.69; P < 0.05). CONCLUSIONS Based on the results of this meta-analysis, we concluded that robotic-assisted technology may be a worthwhile technique to apply in the surgical treatment of total gastrectomy. However, this meta-analysis has the limitations that the included studies were all non-randomized controlled trials and published in Asian countries, and more high-quality randomized controlled trials are needed for further validation in the future. THE REGISTERED NAME AND REGISTRATION NUMBER The study protocol for this meta-analysis is registered on the PROSPERO website under registration number CRD42024500512.
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Affiliation(s)
- Jianhua Chen
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
- General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Fei Wang
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China
| | - Yong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Jie Zhou
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China
| | - Yapeng Yang
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Ziming Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Rongfan Wu
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Liuhua Wang
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, People's Republic of China
- General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Jun Ren
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, People's Republic of China.
- General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China.
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Zhong Q, Tang YH, Liu ZY, Zhang ZQ, He QC, Li P, Xie JW, Wang JB, Lin JX, Lu J, Chen QY, Zheng CH, Huang CM. Long-term survival outcomes of robotic total gastrectomy for locally advanced proximal gastric cancer: a prospective study. Int J Surg 2024; 110:4132-4142. [PMID: 38537085 PMCID: PMC11254278 DOI: 10.1097/js9.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/03/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Robotic gastrectomy is a safe and feasible approach for gastric cancer (GC); however, its long-term oncological efficacy remains unclear. The authors evaluated the long-term survival outcomes and recurrence patterns of patients with locally advanced proximal GC who underwent robotic total gastrectomy (RTG). METHODS This prospective study (FUGES-014 study) enrolled 48 patients with locally advanced proximal GC who underwent RTG between March 2018 and February 2020 at a tertiary referral teaching hospital. Patients who underwent laparoscopic total gastrectomy (LTG) in the FUGES-002 study were enrolled in a 2:1 ratio to compare the survival outcomes between RTG and LTG. The primary endpoint of the FUGES-014 study was postoperative 30-day morbidity and has been previously reported. Here, the authors reported the results of 3-year disease-free survival (DFS), 3-year overall survival (OS), and recurrence patterns. RESULTS After propensity score matching, 48 patients in the RTG and 96 patients in the LTG groups were included. The 3-year DFS rates were 77.1% (95% CI: 66.1-89.9%) for the RTG and 68.8% (95% CI: 60.1-78.7%) for the LTG groups ( P =0.261). The 3-year OS rates were not significantly different between the groups (85.4 vs. 74.0%, P =0.122). Recurrence occurred in nine patients (18.8%) in the RTG and 27 (28.1%) patients in the LTG groups ( P =0.234). Recurrence patterns and causes of death were similar between the groups ( P >0.05). CONCLUSIONS The oncological outcome of RTG was noninferior to that of LTG. Thus, RTG might be an alternative surgical treatment for locally advanced proximal GC.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yi-Hui Tang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Zhi-Quan Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Qi-Chen He
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People’s Republic of China
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Izumi D, Nunobe S, Ishizuka N, Yagi T, Hayami M, Makuuchi R, Ohashi M, Watanabe M, Sano T. Identification of the factor affecting learning curves of laparoscopic gastrectomy through the experience at a Japanese high-volume center over the last decade. Ann Gastroenterol Surg 2024; 8:604-610. [PMID: 38957566 PMCID: PMC11216783 DOI: 10.1002/ags3.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/19/2023] [Accepted: 02/06/2024] [Indexed: 07/04/2024] Open
Abstract
Background Though laparoscopic gastrectomy (LG) has become the gold standard for gastric cancer treatment according to the Japanese treatment guidelines, its learning curve remains steep. Decreasing numbers of surgeons and transitions in the work environment have changed LG training recently. We analyzed LG training over the last decade to identify factors affecting the learning curve. Study Design Laparoscopic distal and pylorus-preserving gastrectomies conducted between 2010 and 2020 were included. We assessed learning curves based on the standard operation time (SOT) defined by analysis of covariance. Then we divided the trainees into two groups based on the length of the learning curve and examined the factors affecting the learning curve with linear regression analysis. Results Among 2335 LGs, 960 cases treated by 27 trainees and 1301 cases treated by six attending surgeons were analyzed. The operation time was prolonged (p = 0.009) and postoperative morbidity rates were lower (p = 0.0003) for cases treated by trainees. Trainees experienced 38 (range, 9-81) cases as scopists and nine (range, 0-41) cases as first assistants to the first operator. The learning curve was approximately 30 cases. The SOT was calculated based on gender, body mass index, tumor location, reconstruction, and lymph node dissection. Trainees who had shorter learning curves had more experience (51-100 cases) with any laparoscopic surgery before LG training than the others (11-50 cases, p = 0.017). Conclusion Sufficient experience with laparoscopic surgery before starting LG training might contribute to the efficiency of LG training and shorten the learning curve.
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Affiliation(s)
- Daisuke Izumi
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
- Department of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Souya Nunobe
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Naoki Ishizuka
- Department of Clinical Trial and ManagementThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Taisuke Yagi
- Department of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
| | - Masaru Hayami
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Rie Makuuchi
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Manabu Ohashi
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Masayuki Watanabe
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Sano
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
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Kitazono M, Fujita M, Uchiyama S, Eguchi M, Ikeda N. Robotic vs. laparoscopic distal gastrectomy for gastric cancer: A propensity score-matched retrospective comparative study at a single institution. Asian J Surg 2024; 47:2598-2605. [PMID: 38538396 DOI: 10.1016/j.asjsur.2024.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/01/2023] [Accepted: 03/06/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Although robotic surgery is becoming more widespread worldwide, it is still in its infancy. This study aimed to confirm the safety and feasibility of the induction of robotic-assisted gastric surgery at a local hospital. METHODS For five years, between 2016 and 2020, 42 laparoscopic and 71 robotic distal gastrectomies were performed at the same institution. Patients diagnosed with gastric cancer were retrieved from the database. Propensity score matching was performed based on covariates such as Age, Sex, BMI, the American Society of Anesthesiologists Physical Status, Tumor Location, pT, and pN. Clinicopathological characteristics, surgical performance, postoperative outcomes, and pathological data were retrospectively collected and compared by the Chi-square test, the Fisher's exact test, the Student's t-test, and the Mann-Whitney U test. RESULTS Billroth II reconstruction was often selected for the robotic group more than the laparoscopic group (59.4% and 15.6%, respectively). In addition, the number of lymph nodes harvested after D2 dissection tended to be more significant in the robotic group than in the laparoscopic group (52.1 ± 7.6 and 29.1 ± 3.7, respectively; p = 0.00934). The mean operative time was 271.4 ± 10.5 min for the robotic group and 220.8 ± 12.3 min for the laparoscopic group (p = 0.00005). There were no differences in short-term clinical outcomes between the two groups. CONCLUSIONS Although a single-center, small comparative study, the results showed that the robotic surgery group was not inferior to the laparoscopic group in feasibility and safety. Moreover, robotic surgery enables harvesting a higher number of lymph nodes, which may be more advantageous than laparoscopic surgery. This study also showed that as the surgeon gains experience with robotic surgery, its operative time becomes significantly shorter.
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Affiliation(s)
- Masaki Kitazono
- Department of Surgery, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan.
| | - Makoto Fujita
- Division of Medical Support, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan
| | | | - Mayumi Eguchi
- Department of Surgery, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan
| | - Naotaka Ikeda
- Department of Surgery, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan
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Lin X, Tan C, Wu W, Liang C, Qian F, Zhao Y. Evaluation of factors influencing long-term and textbook outcomes in laparoscopic gastrectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108002. [PMID: 38330541 DOI: 10.1016/j.ejso.2024.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Textbook outcome (TO) in gastric cancer surgery is a multidimensional measure of surgical quality. However, its impact on long-term survival after laparoscopic gastrectomy (LG) is unclear. This study aims to evaluate TO in LG, assess its hospital-level relevance, and examine its association with long-term survival. METHODS In this retrospective cohort study, we analyzed 2278 consecutive gastric cancer patients who underwent laparoscopic gastrectomy (LG) from January 2004 to December 2017. We determined TO achievement rates, compared preoperative and intraoperative variables between TO and non-TO groups, identified independent predictors of TO, and assessed long-term oncologic outcomes using Kaplan-Meier analysis and Cox regression. RESULTS A total of 1540 LG patients were analyzed, with 994 (64.5%) achieving TO. The least frequently achieved metric was 'hospital stays ≤21 days' (83.4%), followed by 'lymph nodes retrieved ≥15' (84.0%). Factors independently associated with reduced TO likelihood included age ≥65 years, BMI ≥25, ASA III, conversion to open surgery, operation time ≥260 min, and estimated blood loss ≥150 ml. Furthermore, TO was independently linked to improved 5-year overall survival (OS) and disease-free survival (DFS) (HR 0.519 [0.443-0.609] and HR 0.517 [0.443-0.604], respectively). CONCLUSION Implementing the TO concept in LG provides a benchmark for achieving improved prognoses and empowers surgeons to devise strategies for enhancing surgical care quality.
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Affiliation(s)
- Xia Lin
- Institution: Department of Gastrointestinal Surgery, Three Gorges Hospital, Chongqing University, Chongqing, China; Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Chenjun Tan
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Weigao Wu
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Chenglong Liang
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Feng Qian
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Yongliang Zhao
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China.
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Takasu C, Nishi M, Yoshikawa K, Tokunaga T, Kashihara H, Wada Y, Yoshimoto T, Shimada M. Preoperative evaluation to determine the difficulty of No. 6 lymphadenectomy in laparoscopic gastrectomy. BMC Surg 2024; 24:69. [PMID: 38389108 PMCID: PMC10885599 DOI: 10.1186/s12893-024-02349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) requires a long learning curve because of the complicated surgical procedures. Infrapyloric (No. 6) lymph node dissection (LND) is one of the difficult procedures in LG, especially for trainees. This study investigated the impact of the prediction of the difficulty of No. 6 LND. METHODS We retrospectively reviewed the preoperative computed tomography (CT) images and individual operative video records of 57 patients who underwent LG with No. 6 LND to define and predict the No. 6 LND difficulty. To evaluate whether prediction of the difficulty of No. 6 LND could improve surgical outcomes, 48 patients who underwent laparoscopic distal gastrectomy were assessed (30 patients without prediction by a qualified surgeon and 18 patients with prediction by a trainee). RESULTS The anatomical characteristic that LND required > 2 cm of dissection along the right gastroepiploic vein was defined as difficulty of No. 6 LND. Of the 57 LG patients, difficulty was identified intraoperatively in 21 patients (36.8%). Among the several evaluated anatomical parameters, the length between the right gastroepiploic vein and the right gastroepiploic artery in the maximum intensity projection in contrast-enhanced CT images was significantly correlated with the intraoperative difficulty of No. 6 LND (p < 0.0001). Surgical outcomes, namely intraoperative minor bleeding, postoperative pancreatic fistula, and drain amylase concentration were not significantly different between LG performed by a trainee with prediction compared with that by a specialist without prediction. CONCLUSIONS Preoperative evaluation of the difficulty of No. 6 LND is useful for trainees, to improve surgical outcomes.
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Affiliation(s)
- Chie Takasu
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Masaaki Nishi
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kozo Yoshikawa
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hideya Kashihara
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yuma Wada
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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Chan KS, Oo AM. Establishing the Learning Curve of Laparoscopic and Robotic Distal Gastrectomy: a Systematic Review and Meta-Regression Analysis. J Gastrointest Surg 2023; 27:2946-2982. [PMID: 37658172 DOI: 10.1007/s11605-023-05812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Minimally invasive distal gastrectomy (MIDG) is non-inferior compared with open distal gastrectomy for gastric cancer. However, MIDG bears a learning curve (LC). This study aims to evaluate the number of cases required to surmount the LC (i.e. NLC) in MIDG. METHODS PubMed, Embase, Scopus, and the Cochrane Library were systematically searched from inception to August 2022 for studies which reported NLC in MIDG. NLC on reduced-port/single-port MIDG only were separately analysed. Poisson mean (95% confidence interval (CI)) was used to determine NLC. Negative binomial regression was used to compare NLC between laparoscopic distal gastrectomy (LDG) and robotic distal gastrectomy (RDG). RESULTS A total of 45 articles with 71 data sets (LDG n=47, RDG n=24) were analysed. There were 7776 patients in total (LDG n=5516, RDG n=2260). Majority of studies were conducted in East Asia (n=68/71). Majority (76.1%) of data sets used non-arbitrary methods of analyses. The overall NLC for RDG was significantly lower compared to LDG (RDG 22.4 (95% CI: 20.4-24.5); LDG 46.7 (95% CI: 44.1-49.4); incidence rate ratio 0.48, p<0.001). The median number of laparoscopic gastrectomy (LG) cases prior was 0 (interquartile range (IQR) 0-105) for LDG and 159 (IQR 101-305.3) for RDG. Meta-regression analysis did not show a significant impact prior experience in LG, extent of lymphadenectomy and intracorporeal vs extracorporeal anastomosis had on overall NLC for LDG and RDG. CONCLUSION NLC for RDG is shorter compared to LDG, but this may be due to prior experience in LG and ergonomic advantages of RDG.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Aung Myint Oo
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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8
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Jia Z, Cao S, Meng C, Liu X, Li Z, Tian Y, Yu J, Sun Y, Xu J, Liu G, Zhang X, Yang H, Zhong H, Wang Q, Zhou Y. Intraoperative performance and outcomes of robotic and laparoscopic total gastrectomy for gastric cancer: A high-volume center retrospective propensity score matching study. Cancer Med 2023; 12:10485-10498. [PMID: 36924361 PMCID: PMC10225175 DOI: 10.1002/cam4.5785] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Studies on robotic total gastrectomy (RTG) are currently limited. This study aimed to compare the intraoperative performance as well as short- and long-term outcomes of RTG and laparoscopic total gastrectomy (LTG). METHODS A total of 969 patients underwent robotic (n = 161) or laparoscopic (n = 636) total gastrectomy between October 2014 and October 2021. The two groups of patients were matched 1:3 using the propensity score matching (PSM) method. The intraoperative performance as well as short- and long-term outcomes of the robotic (n = 147) and the laparoscopic (n = 371) groups were compared. RESULTS After matching, the estimated intraoperative blood loss was lower (80.51 ± 68.77 vs. 89.89 ± 66.12, p = 0.008), and the total number of lymph node dissections was higher (34.74 ± 12.44 vs. 29.83 ± 12.22, p < 0.001) in the RTG group compared with the LTG group. More lymph node dissections at the upper edge of the pancreas were performed in the RTG group than in the LTG (12.59 ± 4.18 vs. 10.33 ± 4.58, p = 0.001). Additionally, postoperative recovery indicators and laboratory data were greater in the RTG group than those in the LTG group, while postoperative complications were comparable between the two groups (19.0% vs. 18.9%, p = 0.962). For overweight or obese patients with body mass indexes (BMIs) ≥25, certain clinical outcomes of the RTG remained advantageous, and no significant differences in three-year overall survival (OS) or relapse-free survival (RFS) were observed. CONCLUSIONS Robotic total gastrectomy demonstrated better intraoperative performance, could improve the short-term clinical outcomes of patients, and was more conducive to patient recovery. However, the long-term efficacies of the two approaches were similar. Robotic surgical systems may reduce surgical stress responses in patients, allowing them to receive postoperative chemotherapy sooner.
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Affiliation(s)
- Zhuoyu Jia
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Shougen Cao
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Cheng Meng
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Xiaodong Liu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Zequn Li
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yulong Tian
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Junjian Yu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yuqi Sun
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Jianfei Xu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Gan Liu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Xingqi Zhang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Hao Yang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Hao Zhong
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Qingrui Wang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yanbing Zhou
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
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Romero-peña M, Suarez L, Valbuena DE, Rey Chaves CE, Conde Monroy D, Guevara R. Laparoscopic and open gastrectomy for locally advanced gastric cancer: a retrospective analysis in Colombia. BMC Surg 2023; 23:19. [PMID: 36703124 PMCID: PMC9878750 DOI: 10.1186/s12893-023-01901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Radical gastrectomy has traditionally been the pillar treatment with curative intent for malignant tumors of the stomach. The safety of the laparoscopic approach for advanced gastric cancer (AGC) is still under debate. In our institution, laparoscopic gastrectomy is the most performed approach. OBJECTIVE Our aim is to describe the experience of a high-volume center in the treatment of AGC in Colombia and to analyze the short-term results and the overall survival rate at 1, 3, and 5 years comparing the open and laparoscopic approaches. METHODS A cross-sectional retrospective study of patients who underwent gastrectomy for advanced gastric cancer by open or laparoscopic approaches were performed. A Will-Coxon Mann Whitney test was performed in terms of lymph node status and surgical approach. Survival analysis was performed using the Kaplan-Meier method for overall survival at 1, 3, and 5 years. An initial log-rank test was performed to test the relationships between the operative variables and overall survival, the statistical value was accepted if p < 0.20. Data with an initial statistical relationship in the log-rank test were included in a secondary analysis using multivariate Cox proportional regression, variables with a value of p < 0.05 were considered statistically significant. RESULTS 310 patients met the inclusion criteria. 89% underwent laparoscopic gastrectomy and 10.9% open gastrectomy. The resection margins were negative at 93.5% and the In terms of lymph node dissection, the median lymph nodes extracted was 20 (12;37), with statistically significant differences between the approaches in favor of the laparoscopic approach (Median 21 vs 12; z = - 2.19, p = 0.02). The survival rate was at 1, 3, and 5 years of 84.04%, 66.9%, and 65.47% respectively. The presence of complications and the ICU requirement have a negative impact on survival at 1 year (p 0.00). CONCLUSION A laparoscopic approach is safe with acceptable morbidity and mortality rates for treating gastric cancer. D2 Lymphadenectomy could be performed successfully in a laparoscopic approach in a high-volume center and a properly standardized technique. Major postoperative morbidity with intensive care unit requirement seems to influence overall survival rates.
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Affiliation(s)
| | - Liliana Suarez
- Clínica Universitaria Colombia, Bogotá D.C, 110111 Colombia
| | | | - Carlos Eduardo Rey Chaves
- grid.41312.350000 0001 1033 6040School of Medicine, Pontificia Universidad Javeriana, Carrera 6A# 51A - 48, Bogotá D.C, 110111 Colombia
| | - Danny Conde Monroy
- grid.412191.e0000 0001 2205 5940Hospital Universitario Mayor - Méderi, Universidad del Rosario, Bogotá D.C, 110111 Colombia
| | - Raúl Guevara
- Clínica Universitaria Colombia, Bogotá D.C, 110111 Colombia
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10
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Seika P, Biebl M, Raakow J, Kröll D, Çetinkaya-Hosgör C, Thuss-Patience P, Maurer MM, Dobrindt EM, Pratschke J, Denecke C. The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients. J Clin Med 2022; 11:jcm11226841. [PMID: 36431318 PMCID: PMC9698309 DOI: 10.3390/jcm11226841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Hand-assisted laparoscopic total gastrectomy (LTG) for patients with gastric cancer (GC) has been established as the standard surgical treatment at our center. This study aims to quantify the learning curve for surgeons performing minimally invasive total gastrectomy at a high-volume single center. (2) Methods: One hundred and eighteen consecutive patients who underwent minimally invasive total gastrectomy between January 2014 and December 2020 at a single high-volume center were included and reviewed retrospectively. Risk-adjusted cumulative sum analysis (RA-CUSUM) was used to monitor the surgical outcomes for patients with different risks of postoperative mortality using varying-coefficient logistic regression models. Patients were ordered by the sequential number of the procedure performed and divided into two groups according to the degree of surgeon proficiency as determined by RA-CUSUM analysis (group A: 45; group B: 73 patients). Age, gender, body mass index (BMI), tumor location, pathology, and comorbidities were compared while primary endpoints comprised surgical parameters, postoperative course, and survival outcomes. (3) Results: Forty-four cases were required for the completion of the learning curve. During this time, the mean operating time decreased. Hand-assisted laparoscopic total gastrectomy performed after a learning curve was associated with a shorter median operating time (OT) (360 min vs. 289 min, <0.001), and a reduced length of stay (A = 18.0 vs. B = 14.0 days) (p = 0.154), while there was a trend toward less major complications (Clavien−Dindo (CD) 3−5 within 90 days (12 (26.67%) vs. 10 (13.70%) p = 0.079). Our results showed no difference in anastomotic leakage between the two groups (group A vs. group B, 3 (6.67%) vs. 4 (5.48%) p = 0.99). Similarly, 30-day (0 (0%) vs. 1 (1.7%), p = 0.365) and 90-day mortality (1 (2.08%) vs. 2 (3.39%), p = 0.684) were comparable. Following multivariate analysis, the level of surgical proficiency was not a significant prognostic factor for overall survival. (4) Conclusions: A minimum of 44 cases are required for experienced laparoscopic surgeons to achieve technical competence for performing LTG. While operation time decreased after completion of the learning curve, quality criteria such as achievement of R0 resection, anastomotic leakage, and perioperative mortality remained unaltered. Of note, the level of surgical training showed no significant impact on the 2 year OS or DFS.
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Affiliation(s)
- Philippa Seika
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Matthias Biebl
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Surgery, Ordensklinikum Linz, 4020 Linz, Austria
| | - Jonas Raakow
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Dino Kröll
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Candan Çetinkaya-Hosgör
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Peter Thuss-Patience
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Max Magnus Maurer
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health, 13353 Berlin, Germany
| | - Eva Maria Dobrindt
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Johann Pratschke
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Christian Denecke
- Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence:
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11
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Chen QY, Zhong Q, Liu ZY, Li P, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Lin GT, Zheng CH, Huang CM, Xie JW. Surgical Outcomes, Technical Performance, and Surgery Burden of Robotic Total Gastrectomy for Locally Advanced Gastric Cancer: A Prospective Study. Ann Surg 2022; 276:e434-e443. [PMID: 33491975 DOI: 10.1097/sla.0000000000004764] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the short-term outcomes, surgery burden, and technical performance of robotic total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) for gastric cancer (GC). SUMMARY OF BACKGROUND DATA The impact of robotic systems on total gastrectomy remains obscure. METHODS This prospective study included 50 patients with advanced proximal GC underwent RTG combined with spleen-preserving splenic hilar lymphadenectomy between March 2018 and February 2020. Patients who underwent LTG in the FUGES-002, http://links.lww.com/SLA/C929 study were enrolled to compare the outcomes between RTG and LTG. RESULTS After propensity score matching, 48 patients in the RTG group and 96 patients in the LTG group were included in the analysis. The RTG group had a lower volume of intraoperative blood loss than the LTG group (38.7 vs 66.4 mL, P = 0.042). Significantly more extraperigastric lymph nodes were retrieved in the RTG group than in the LTG group (20.2 vs 17.5, P = 0.039). The average number of errors was lower in the RTG group than in the LTG group (43.2 vs 53.8 times/case, P < 0.001). The RTG group had a higher technical skill score (30.2 vs 28.4, P < 0.001) and a lower surgery task load index (33.2 vs 39.8, P < 0.001) than the LTG group. No significant difference was found in terms of postoperative morbidity between the 2 groups (14.6% vs 16.7%, P = 0.748). CONCLUSIONS In complex total gastrectomy for GC, compared with traditional laparoscopic surgery, robotic surgery provides a technically superior operative environment and reduces surgeon workload at high-volume specialized institutions.
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Affiliation(s)
- Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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12
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Wang ZK, Lin JX, Wang FH, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Li P, Zheng CH, Huang CM. Robotic spleen-preserving total gastrectomy shows better short-term advantages: a comparative study with laparoscopic surgery. Surg Endosc 2022; 36:8639-8650. [PMID: 35697854 DOI: 10.1007/s00464-022-09352-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Robotic surgery may be advantageous for complex surgery. We aimed to compare the intraoperative and postoperative short-term outcomes of spleen-preserving splenic hilar lymphadenectomy (SPSHL) during robotic and laparoscopic total gastrectomy. METHODS From July 2016 to December 2020, the clinicopathological data of 115 patients who underwent robotic total gastrectomy combined with robotic SPSHL (RSPSHL) and 697 patients who underwent laparoscopic total gastrectomy combined with laparoscopic SPSHL (LSPSHL) were retrospectively analyzed. A 1:2 ratio propensity score matching (PSM) was used to balance the differences between the two groups to compare their outcomes. The Generic Error Rating Tool was used to evaluate the technical performance. RESULTS After PSM, the baseline preoperative characteristics of the 115 patients in the RSPSHL and 230 patients in the LSPSHL groups were balanced. The dissection time of the region of the splenic artery trunk (5.4 ± 1.9 min vs. 7.8 ± 3.6 min, P < 0.001), the estimated blood loss during SPSHL (9.6 ± 4.8 ml vs. 14.9 ± 7.8 ml, P < 0.001), and the average number of intraoperative technical errors during SPSHL (15.1 ± 3.4 times/case vs. 20.7 ± 4.3 times/case, P < 0.001) were significantly lower in the RSPSHL group than in the LSPSHL group. The RSPSHL group showed higher dissection rates of No. 10 (78.3% vs. 70.0%, P = 0.104) and No. 11d (54.8% vs. 40.4%, P = 0.012) lymph nodes and significantly improved postoperative recovery results in terms of times to ambulation, first flatus, and first intake (P < 0.05). The splenectomy rates of the two groups were similar (1.7% vs. 0.4%, P = 0.539), and there was no significant difference in morbidity and mortality within postoperative 30 days (13.0% vs. 15.2%, P = 0.589). CONCLUSION Compared to LSPSHL, RSPSHL has more advantages in terms of surgical qualities and postoperative recovery process with similar morbidity and mortality. For complex SPSHL, robotic surgery may be a better choice.
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Affiliation(s)
- Zu-Kai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Fu-Hai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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Coit DG, Strong VE. Fifty years of progress in gastric cancer. J Surg Oncol 2022; 126:865-871. [PMID: 36087088 PMCID: PMC9469502 DOI: 10.1002/jso.27060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
As with every human malignancy, the diagnosis, staging, and treatment of patients with gastric cancer have undergone enormous evidence-based change over the last 50 years, largely as a result of increasingly rapid developments in technology and science. Some of the changes in clinical practice have derived from prospective randomized controlled trials (RCTs), whereas others have come from study of meticulously maintained prospective databases, which define the disease's natural history over time, and occasionally from in-depth analysis of a single patient with an unexpectedly good or poor outcome. Herein we summarize the more important changes in gastric cancer management and the data supporting those changes.
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Affiliation(s)
- Daniel G Coit
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivian E Strong
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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14
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Nishi M, Shimada M, Yoshikawa K, Tokunaga T, Kashihara H, Takasu C, Yoshimoto T, Iwahashi S. Usefulness of a stepwise training program for laparoscopic gastrectomy. Asian J Endosc Surg 2022; 15:121-127. [PMID: 34514719 DOI: 10.1111/ases.12979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Laparoscopic gastrectomy (LG) is a complicated procedure with a long learning curve. This study was performed to investigate the usefulness of our stepwise training program for LG for improving the quality of the surgery. METHODS The stepwise training method comprised the following four steps: (1) basic training using a dry box and checking by mentors; (2) advanced training, including the use of animals and cadavers; (3) clinical experience, including standardization and preoperative three-dimensional simulation; and (4) self-assessment and feedback. In total, 153 patients who underwent curative gastrectomy for gastric cancer were included in this study. RESULTS The operative time gradually decreased for both laparoscopic distal gastrectomy (LDG) (2013, 395 minutes; 2017, 278 minutes; P < .001; ρ = -0.68) and laparoscopic total gastrectomy (LTG) (2013, 476 minutes; 2017, 319 minutes; P < .001; ρ = -0.56). The blood loss volume gradually decreased for both LDG (2013, 43.0 mL; 2017, 18.6 mL; P < .005; ρ = -0.30) and LTG (2013, 143.8 mL; 2017, 13.5 mL; P < .005; ρ = -0.41). CONCLUSIONS Our stepwise training program contributes to reduce operation time and blood loss in LG.
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Affiliation(s)
- Masaaki Nishi
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Mitsuo Shimada
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Kozo Yoshikawa
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Takuya Tokunaga
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Hideya Kashihara
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Chie Takasu
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Shoko Iwahashi
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
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15
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Laparoscopic versus open distal gastrectomy for gastric cancer: A systematic review and meta-analysis. Surgery 2022; 171:1552-1561. [DOI: 10.1016/j.surg.2021.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
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16
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Shibasaki S, Suda K, Nakauchi M, Nakamura K, Tanaka T, Kikuchi K, Inaba K, Uyama I. Impact of the Endoscopic Surgical Skill Qualification System on the safety of laparoscopic gastrectomy for gastric cancer. Surg Endosc 2021; 35:6089-6100. [PMID: 33090314 DOI: 10.1007/s00464-020-08102-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND We hypothesized that the Endoscopic Surgical Skill Qualification System (ESSQS) can shorten operative time, resulting in a decrease in postoperative morbidity. Here, we aimed to clarify whether ESSQS-qualified surgeons could decrease the incidence of complications. METHODS Between January 2009 and June 2019, 1042 patients diagnosed with both clinical and pathological Stage ≤ III gastric cancer and undergoing LG were enrolled. In all LG procedures involving ESSQS-qualified surgeons, these served as the operator or the instructive assistant. The short-term outcomes were retrospectively compared between the ESSQS-qualified and the non-ESSQS-qualified surgeons using a propensity-score matched analysis. RESULTS After propensity-score matching, 321 patients were included in each group. No significant differences were observed in morbidity rate, and length of hospitalization following surgery, although the non-ESSQS-qualified surgeon group had a significantly longer total operative time (Non-ESSQS-qualified group, 368 [170-779] min vs. ESSQS-qualified group, 316 [147-772] min; p < 0.001), and larger estimated blood loss (Non-ESSQS-qualified group, 28 [0-702] mL vs. ESSQS-qualified group 25, [0-1069] mL; p = 0.042). Multivariate analysis revealed that operative time ≥ 360 min (OR 1.818 [1.069-3.094], p = 0.027) was identified as the only significant independent risk factor determining morbidity. CONCLUSIONS The incidence of postoperative morbidity did not differ between patients operated by the qualified and nonqualified surgeons, as long as ESSQS-qualified surgeons provide intraoperative instructions.
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Affiliation(s)
- Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Masaya Nakauchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tsuyoshi Tanaka
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenji Kikuchi
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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17
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Zhang W, Huang Z, Zhang J, Che X. Long-term and short-term outcomes after laparoscopic versus open surgery for advanced gastric cancer: An updated meta-analysis. J Minim Access Surg 2021; 17:423-434. [PMID: 34558423 PMCID: PMC8486067 DOI: 10.4103/jmas.jmas_219_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The efficacy of laparoscopy for advanced gastric cancer (AGC) remains controversial. MATERIALS AND METHODS We conducted a literature search on the EMBASE, PubMed and Cochrane Library databases to identify relevant available articles published between the time of the databases' inception and July 2020. RESULTS A total of 14,689 patients were included in the 41 studies identified. A total of 6976 patients were in an laparoscopic approach group (LG) and 7713 patients were in an open approach group (OG). The meta-analysis showed that in randomized control trials (RCTs), LG were better than OG in terms of estimated blood loss, time to oral intake and time to first flatus while the operation time and proximal resection margin (PRM) were significantly worse in LG than in OG. In the non-RCTs, LG had shorter hospital stays, less blood loss, less intraoperative transfusion, less time to oral intake, time to first flatus, time to ambulation; less overall or serious complications; and better 3-year and 5-year overall or disease-free survival (DFS). Operation times and PRM were significantly worse for LGs. CONCLUSION The safety and effectiveness of laparoscopic surgery for AGC is not inferior to that of traditional open surgery, and to a certain extent, can reduce trauma, facilitate recovery, and be validated in RCTs and non-RCTs. In the real-world cohort, laparoscopic surgery for gastric cancer achieved a better survival rate and DFS rate. However, to evaluate the efficacy of these two methods more comprehensively, high-quality randomized controlled trials and longer follow-up times are still needed.
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Affiliation(s)
- Wei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Zhangkan Huang
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Jianwei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Xu Che
- Department of Pancreatic and Gastric Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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18
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Kikuchi K, Suda K, Shibasaki S, Tanaka T, Uyama I. Challenges in improving the minimal invasiveness of the surgical treatment for gastric cancer using robotic technology. Ann Gastroenterol Surg 2021; 5:604-613. [PMID: 34585045 PMCID: PMC8452474 DOI: 10.1002/ags3.12463] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/16/2021] [Accepted: 03/28/2021] [Indexed: 12/14/2022] Open
Abstract
The number of operations performed using the da Vinci Surgical System® (DVSS) has been increasing worldwide in the past decade. We introduced robotic gastrectomy for gastric cancer (GC) in January 2009 to overcome the disadvantage of conventional laparoscopic gastrectomy. Initially, we experienced some troubles in the technical aspect and cost of robotic surgery. After extensive trial and error, we were able to develop the "double bipolar method" and the "da Vinci's plane theory" to use DVSS effectively. We then conducted "Senshiniryo B," which was a multi-institutional prospective single-arm study to determine the safety, feasibility, and effectiveness of robotic gastrectomy for GC in 2014. In that study, we demonstrated that the morbidity rate in the robotic group (2.45%) was significantly lower than that in the historical control group (6.4%). As a consequence of that clinical trial, 12 procedures, including robotic gastrectomy for GC, have been covered under the Japanese national insurance in 2018. An additional seven procedures were newly covered in April 2020. In the first half of this article, we describe the history of robotic surgery in the world and Japan and demonstrate the "double bipolar method" and "da Vinci's plane theory." In the latter half, we explain the Japanese systems for the safe dissemination of robotic surgery and state our efforts to solve some problems in robotic surgery.
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Affiliation(s)
- Kenji Kikuchi
- Department of SurgeryFujita Health University Okazaki Medical CenterOkazakiJapan
| | - Koichi Suda
- Department of SurgeryFujita Health UniversityKutsukake, ToyoakeJapan
- The Collaborative Laboratory for Research and Development in Advanced Surgical TechnologyFujita Health UniversityKutsukake, ToyoakeJapan
| | - Susumu Shibasaki
- Department of SurgeryFujita Health UniversityKutsukake, ToyoakeJapan
| | - Tsuyoshi Tanaka
- The Collaborative Laboratory for Research and Development in Advanced Surgical TechnologyFujita Health UniversityKutsukake, ToyoakeJapan
| | - Ichiro Uyama
- Department of SurgeryFujita Health UniversityKutsukake, ToyoakeJapan
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19
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Shin HJ, Son SY, Wang B, Roh CK, Hur H, Han SU. Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Propensity Score-weighted Analysis of 2084 Consecutive Patients. Ann Surg 2021; 274:128-137. [PMID: 32187032 DOI: 10.1097/sla.0000000000003845] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias. SUMMARY OF BACKGROUND DATA Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG). METHODS Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model. RESULTS After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P = 0.498). CONCLUSIONS After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.
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Affiliation(s)
- Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Department of Transplantation and Vascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Bo Wang
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Chul Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University School of Medicine, Suwon, Korea
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20
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Kikuchi S, Kagawa T, Kuroda S, Nishizaki M, Takata N, Kuwada K, Shoji R, Kakiuchi Y, Mitsuhashi T, Umeda Y, Noma K, Kagawa S, Fujiwara T. Accreditation as a qualified surgeon improves surgical outcomes in laparoscopic distal gastrectomy. Surg Today 2021; 51:1978-1984. [PMID: 34050804 DOI: 10.1007/s00595-021-02309-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/25/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE The Endoscopic Surgical Skill Quantification System for qualified surgeons (QSs) was introduced in Japan to improve surgical outcomes. This study reviewed the surgical outcomes after initial experience performing laparoscopic distal gastrectomy (LDG) and evaluated the improvement in surgical outcomes following accreditation as a QS. METHODS Eighty-seven consecutive patients who underwent LDG for gastric cancer by a single surgeon were enrolled in this study. The cumulative sum method was used to analyze the learning curve for LDG. The surgical outcomes were evaluated according to the two phases of the learning curve (learning period vs. mastery period) and accreditation (non-QS period vs. QS period). RESULTS The learning period for LDG was 48 cases. Accreditation was approved at the 67th case. The operation time and estimated blood loss were significantly reduced in the QS period compared to the non-QS period (230 vs. 270 min, p < 0.001; 20.5 vs. 59.8 ml, p = 0.024, respectively). Furthermore, the major complication rate was significantly lower in the QS period than in the non-QS period (0 vs. 10.6%, p = 0.044). CONCLUSIONS Experience performing approximately 50 cases is required to reach proficiency in LDG. After receiving accreditation as a QS, the surgical outcomes, including the complication rate, were improved.
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Affiliation(s)
- Satoru Kikuchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Tetsuya Kagawa
- Department of Gastroenterological Surgery, Shikoku Cancer Center, Matsuyama, 791-0280, Japan
| | - Shinji Kuroda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masahiko Nishizaki
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nobuo Takata
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazuya Kuwada
- Department of Surgery, Okayama Red Cross Hospital, Okayama, 700-8607, Japan
| | - Ryohei Shoji
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoshihiko Kakiuchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Yuzo Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazuhiro Noma
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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21
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Kim YM, Hyung WJ. Current status of robotic gastrectomy for gastric cancer: comparison with laparoscopic gastrectomy. Updates Surg 2021; 73:853-863. [PMID: 33394356 DOI: 10.1007/s13304-020-00958-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/24/2022]
Abstract
Robotic systems were developed to overcome limitations of laparoscopic surgery with its mechanical advantages. Along with the technical advances, robotic gastrectomy for gastric cancer is increasing. However, the evidence regarding safety and efficacy for robotic gastrectomy for gastric cancer is not mature yet. Although studies are limited, it is evident that robotic gastrectomy has a longer operation and less blood loss compared with laparoscopic gastrectomy. Studies revealed long-term oncological outcomes after robotic gastrectomy was comparable to those after laparoscopic gastrectomy. Taken together, robotic gastrectomy with systemic lymph node dissection is suggested as a safe procedure with equivalent short- and long-term oncologic outcomes to either laparoscopic or open gastrectomy for the surgical treatment of gastric cancer. However, high cost is the most significant barrier to justify robotic surgery as a routine and standard treatment for patients with gastric cancer. In the meanwhile, robotic surgery will be expansively used as long as technologic developments continue.
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Affiliation(s)
- Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
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22
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Hur H, Roh CK, Son SY, Han SU. How could we make clinical evidence for early recovery after surgery (ERAS) in minimally invasive surgery for gastric cancer? J Surg Oncol 2020; 122:361-362. [PMID: 32419192 DOI: 10.1002/jso.25955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Hoon Hur
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Chul Kyu Roh
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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23
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Park HA, Park SH, Cho SI, Jang YJ, Kim JH, Park SS, Mok YJ, Kim CS. Impact of Age and Comorbidity on the Short-Term Surgical Outcome after Laparoscopy-Assisted Distal Gastrectomy for Adenocarcinoma. Am Surg 2020. [DOI: 10.1177/000313481307900123] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this study was to determine whether age and comorbidity are valuable risk factors of the short-term surgical outcome after laparoscopy-assisted distal gastrectomy (LADG) in patients with adenocarcinoma. A series of 387 patients who underwent LADG at three university hospitals between March 2006 and December 2010 were retrospectively studied. To compare the short-term surgical outcomes of LADG of elderly patients with those of younger patients, patients were categorized into an elderly group (older than 70 years of age) and a younger group (70 years of age or younger). For another comparative analysis to identify risk factors of postoperative complications after LADG, patients were categorized into two groups: those with complications and those without complications. With the exception of sex ratio and comorbidity rate, two age groups were nonsignificantly different in terms of demographic, operative, pathologic, and short-term surgical outcome data. Our data support the safety and feasibility of LADG in elderly patients. However, our data show that comorbidity is an important predictor of postoperative systemic complications after LADG. Patients with an age-adjusted Charlson comorbidity index (CCI) of 3 or greater were found to be at a greater risk of developing systemic complications, which suggests that age-adjusted CCI is a useful predictor of systemic complications after LADG and that it could be used routinely for the perioperative care of aged patients with comorbidity. We recommend age-adjusted CCI be used in comparative clinical research studies on the surgical outcomes across surgeons and hospitals.
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Affiliation(s)
- Han-A Park
- Korea University School of Medicine, Seoul, Korea
| | - Seong-Heum Park
- Department of Surgery, Korea University College of Medicine, Sungbook-gu, Seoul, Korea
| | - Sung-Il Cho
- Department of Surgery, Korea University College of Medicine, Sungbook-gu, Seoul, Korea
| | - You-Jin Jang
- Department of Surgery, Korea University College of Medicine, Sungbook-gu, Seoul, Korea
| | - Jong-Han Kim
- Department of Surgery, Korea University College of Medicine, Sungbook-gu, Seoul, Korea
| | - Sung-Soo Park
- Department of Surgery, Korea University College of Medicine, Sungbook-gu, Seoul, Korea
| | - Young-Jae Mok
- Department of Surgery, Korea University College of Medicine, Sungbook-gu, Seoul, Korea
| | - Chong-Suk Kim
- Department of Surgery, Korea University College of Medicine, Sungbook-gu, Seoul, Korea
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24
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Nishi M, Yoshikawa K, Higashijima J, Tokunaga T, Takasu C, Kashihara H, Ishikawa D, Shimada M. Utility of virtual three-dimensional image analysis for laparoscopic gastrectomy conducted by trainee surgeons. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 66:280-284. [PMID: 31656289 DOI: 10.2152/jmi.66.280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose The aim of this study was to investigate the utility the three-dimensional (3D) imaging for laparoscopic gastrectomy performed by trainee surgeons. Methods 3D-reconstruction was performed using multi-detector computed tomography (MDCT) and SYNAPSE VINCENT software. Trainee surgeons made 3D-imaging and checked the anatomical structure. Thirty-three patients who underwent laparoscopic gastrectomy (LG) for gastric cancer were examined. Trainees performed 19 LG, while specialists performed 14 LG. The vascular pattern and the surgical outcomes were evaluated. Result 3D imaging depicted the correct positional relationship between the gastric vasculatures and the organs. Regarding vascular pattern detected by 3D imaging, the origins of the infrapyloric artery were the right gastroepiploic artery in 12 cases (36%), the gastroduodenal artery in eight cases (24%), the bifurcation of the right gastroepiploic artery and gastroduodenal artery in seven cases (21%), and not detected in one case (3%). The types of confluence of the infrapyloric vein were the right gastroepiploic vein in 16 cases (48%), the anterior superior pancreatoduodenal vein in 10 cases (30%), and not detected in seven cases (21%). Surgical outcomes were not different between trainee group using intraoperative 3D image with the specialist in instruction group without the intraoperative 3D image. Conclusions Preoperative 3D imaging might contribute to successful and safe LG by trainee surgeons. J. Med. Invest. 66 : 280-284, August, 2019.
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Affiliation(s)
- Masaaki Nishi
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Kozo Yoshikawa
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Jun Higashijima
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Takuya Tokunaga
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Chie Takasu
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Hideya Kashihara
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Daichi Ishikawa
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
| | - Mitsuo Shimada
- Department of Surgery, University of Tokushima Graduate School, Tokushima, Japan
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25
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Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure infrapyloric lymph node dissection during laparoscopic distal gastrectomy. Surg Today 2020; 50:1187-1196. [PMID: 32246228 DOI: 10.1007/s00595-020-01993-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/06/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE We aimed to investigate the usefulness of near-infrared indocyanine green (ICG)-enhanced fluorescence guidance for infrapyloric LN dissection in laparoscopic distal gastrectomy. METHODS This study enrolled patients with early gastric cancer scheduled for laparoscopic distal gastrectomy. After intraoperative submucosal injection of ICG (0.1 mg/mL), LN dissection was conducted under near-infrared ICG fluorescence guidance. The operation time, bleeding events during infrapyloric LN dissection were analyzed. Cases were retrospectively 1:3 propensity-score matched to patients who underwent laparoscopic distal gastrectomy without ICG injection. RESULTS The mean time from midline omentectomy to exposure of the right gastroepiploic vein was significantly shorter in the ICG group (n = 20) than in the non-ICG group (n = 60) (13.05 ± 5.77 vs 18.68 ± 7.92 min; p = 0.001), and the incidence of bleeding during infrapyloric LN dissection was lower in the ICG group (20% vs 68.3%, p < 0.001). The two groups did not differ significantly regarding the number of LNs retrieved from the infrapyloric area (p = 0.434). CONCLUSIONS Near-infrared ICG fluorescence guidance facilitates safe and fast infrapyloric LN dissection in laparoscopic distal gastrectomy.
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26
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Ju MR, Wang SC, Zeh HJ, Porembka MR. Minimally invasive gastrectomy for cancer and anastomotic options. J Surg Oncol 2020; 122:49-60. [PMID: 32200555 DOI: 10.1002/jso.25904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
In this review article, we explore patient selection criteria for minimally invasive surgery (MIS) gastrectomy, present evidence on the risks and benefits of minimally invasive techniques, describe operative techniques focusing specifically on reconstruction options, and discuss the learning curve associated with these operations.
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Affiliation(s)
- Michelle R Ju
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sam C Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew R Porembka
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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27
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Shibasaki S, Suda K, Nakauchi M, Nakamura K, Kikuchi K, Inaba K, Uyama I. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis. World J Gastroenterol 2020; 26:1172-1184. [PMID: 32231421 PMCID: PMC7093317 DOI: 10.3748/wjg.v26.i11.1172] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Minimally invasive surgery for gastric cancer (GC) has gained widespread use as a safe curative procedure especially for early GC. AIM To determine risk factors for postoperative complications after minimally invasive gastrectomy for GC. METHODS Between January 2009 and June 2019, 1716 consecutive patients were referred to our division for primary GC. Among them, 1401 patients who were diagnosed with both clinical and pathological Stage III or lower GC and underwent robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) were enrolled. Retrospective chart review and multivariate analysis were performed for identifying risk factors for postoperative morbidity. RESULTS Morbidity following minimally invasive gastrectomy was observed in 7.5% of the patients. Multivariate analyses demonstrated that non-robotic minimally invasive surgery, male gender, and an operative time of ≥ 360 min were significant independent risk factors for morbidity. Therefore, morbidity was compared between RG and LG. Accordingly, propensity-matched cohort analysis revealed that the RG group had significantly fewer intra-abdominal infectious complications than the LG group (2.5% vs 5.9%, respectively; P = 0.038), while no significant differences were noted for other local or systemic complications. Multivariate analyses of the propensity-matched cohort revealed that non-robotic minimally invasive surgery [odds ratio = 2.463 (1.070-5.682); P = 0.034] was a significant independent risk factor for intra-abdominal infectious complications. CONCLUSION The findings showed that robotic surgery might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.
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Affiliation(s)
- Susumu Shibasaki
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Masaya Nakauchi
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Kenji Kikuchi
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Kazuki Inaba
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
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Kong Y, Cao S, Liu X, Li Z, Wang L, Lu C, Shen S, Zhu H, Zhou Y. Short-Term Clinical Outcomes After Laparoscopic and Robotic Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis. J Gastrointest Surg 2020; 24:531-539. [PMID: 30937714 DOI: 10.1007/s11605-019-04158-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/05/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The different advantages of laparoscopic gastrectomy (LG) and robotic gastrectomy (RG), two new minimally invasive surgical techniques for gastric cancer, remain controversial. PURPOSE To compare the short-term clinical outcomes of LG and RG. METHODS A retrospective, single-center comparative study of 1044 patients (LG = 750, RG = 294) was conducted. Patients undergoing LG and RG were matched (2:1 ratio) according to sex, age, BMI, extent of gastric resection, and pathologic stage. The primary outcomes were morbidity and mortality and perioperative recovery parameters; major types of complications were also analyzed. RESULTS After matching, 798 patients (LG = 532, RG = 266) were included. Both the LG and RG groups showed similar overall complication rates (LG = 12.8% vs RG = 12.4%) and operative mortality (LG = 0.4% vs RG = 0.4%). Compared to those who underwent LG, patients undergoing RG had significantly longer operative times (236.92 ± 57.28 vs 217.77 ± 65.00 min, p < 0.001), higher total costs (US$16,241.42 vs US$12,497, p < 0.001), less operative blood loss (77.07 ± 64.37 vs 103.68 ± 86.92 ml, p < 0.001), higher numbers of retrieved lymph nodes (32.0 vs 29.9, p < 0.001), and higher rates of retrieving more than 16 lymph nodes (94.0 vs 85.5%; p < 0.001). No significant differences between groups were noted in terms of the rate of reoperation, time until a soft diet was consumed, or length of hospital stay. The major complication and readmission rates were similar in both groups. CONCLUSION RG and LG produced similar short-term clinical outcomes, indicating that RG is a safe and beneficial surgical procedure.
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Affiliation(s)
- Ying Kong
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China.,Department of Gastrointestinal Surgery, Jining No. 1 People's Hospital, No. 6 Jiankang Road, Central District, Jining City, 272013, Shandong Province, People's Republic of China.,Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 16# Hehua Road, Beihu New District, Jining City, 272067, Shandong, People's Republic of China
| | - Shougen Cao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Xiaodong Liu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Zequn Li
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Liankai Wang
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Cunlong Lu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Shuai Shen
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Houxin Zhu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Yanbing Zhou
- Department of General Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China.
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The optimal timing of additional surgery after non-curative endoscopic resection to treat early gastric cancer: long-term follow-up study. Sci Rep 2019; 9:18331. [PMID: 31797969 PMCID: PMC6892792 DOI: 10.1038/s41598-019-54778-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022] Open
Abstract
Patients with early gastric cancer (EGC) who undergo non-curative endoscopic resection (ER) require additional surgery. The aim of the study was to validate surgical and oncological outcomes according to the timing of additional surgery after non-curative endoscopic resection. We retrospectively analyzed long-term follow-up data on the 302 patients enrolled between January 2007 and December 2014. We validated our earlier suggestion that the optimal time interval from non-curative ER to additional surgery was 29 days. All patients were divided into two groups by reference to time intervals from ER to additional surgery of ≤29days (n = 133; group A) and >29 days (n = 169; group B). The median follow-up duration was 41.98 ± 21.23 months. As in our previous study, group B exhibited better surgical outcomes. A total of 10 patients developed locoregional or distant recurrences during the follow-up period, but no significant difference was evident between the two groups. Interestingly, the survival rate was better in group B. Group B (>29 days) exhibited better surgical and oncological outcomes. Thus, additional gastrectomy after non-curative ER should be delayed for 1 month to ensure optimal surgical and oncological outcomes.
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Lee B, Suh SW, Choi Y, Han HS, Yoon YS, Cho JY, Kim KH, Hyun IG, Han SJ. Solo single incision laparoscopic cholecystectomy using the parallel method; Surgical technique reducing a steep learning curve. Ann Hepatobiliary Pancreat Surg 2019; 23:344-352. [PMID: 31825000 PMCID: PMC6893057 DOI: 10.14701/ahbps.2019.23.4.344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/14/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022] Open
Abstract
Backgrounds/Aims To describe the techniques, short-term outcomes, and learning curve of solo single-incision laparoscopic cholecystectomy (Solo-SILC) using a laparoscopic scope holder. Methods A total of 591 patients who underwent Solo-SILC from July 2014 to December 2016 performed by four experienced hepatobiliary surgeons were retrospectively assessed. Solo-SILC was performed using the parallel method using a scope holder. The moving average method was used to investigate the learning curve in terms of operative time. Results In total, 590 Solo-SILC procedures were performed. Very few procedures were converted to multi-port laparoscopic cholecystectomy. There was one case of bile duct injury. The mean operative time (59.93±25.77 min) was shorter than that in other studies of SILC. Three postoperative complications, delaying bile leakage, occurred in the patients treated by one surgeon. These cases were resolved by ultrasound-guided puncture and drainage. The learning curve for surgeons A, B, and C was overcome after 14, 12, and 12 cases. Surgeon D, who had the most experience with SILC, had no obvious learning curve. Conclusions Hepatobiliary surgeons experienced in LC can perform Solo-SILC almost immediately. Solo-SILC using the parallel technique represents a more stable option and is a promising treatment for gallbladder disease.
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Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Suk-Won Suh
- Department of Surgery, Chung-Ang University, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kil Hwan Kim
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Gun Hyun
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun Jong Han
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee B, Choi Y, Han H, Yoon Y, Cho JY, Kim S, Kim KH, Hyun IG. Comparison of pure laparoscopic and open living donor right hepatectomy after a learning curve. Clin Transplant 2019; 33:e13683. [DOI: 10.1111/ctr.13683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/21/2019] [Accepted: 07/27/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Boram Lee
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
| | - YoungRok Choi
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
| | - Ho‐Seong Han
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
| | - Yoo‐Seok Yoon
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
| | - Jai Young Cho
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
| | - Sungho Kim
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
| | - Kil Hwan Kim
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
| | - In Gun Hyun
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University Seongnam South Korea
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Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients. World J Surg Oncol 2019; 17:86. [PMID: 31122260 PMCID: PMC6533666 DOI: 10.1186/s12957-019-1628-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Data regarding the long-term oncological outcomes of robotic gastrectomy (RG) are limited despite the increased commonality of this method as an alternative for gastric cancer treatment. Here, we conducted a meta-analysis to evaluate the long-term oncological outcomes of RG in comparison to that of laparoscopic gastrectomy (LG). METHODS The PubMed, ISI Web of Science, EMBASE, and Cochrane Library databases were comprehensively searched for studies that compared RG and LG in terms of their long-term survival outcomes. The hazard ratios (HRs) of overall survival (OS), disease-free survival (DFS), and relapse-free survival (RFS) were obtained, while the odds ratio (OR) was recorded for the recurrence rate. A sensitivity analysis was performed. Egger's test and Begg's test were applied to evaluate publication bias. RESULTS Eight studies were identified and involved 3410 gastric cancer patients (RG, 1009; LG, 2401). The two groups had no significant differences in OS (HR, 0.98; 95% CI, 0.80-1.20; P = 0.81), DFS (HR, 1.36; 95% CI, 0.33-5.59; P = 0.67), RFS (HR, 0.92; 95% CI, 0.72-1.19; P = 0.53), or recurrence rate (OR, 0.92; 95% CI, 0.71-1.19; P = 0.53). Moreover, the two techniques were comparable in length of hospital stay (LOS), postoperative complication rate, 30-day mortality rate, and rate of conversion to open surgery. CONCLUSIONS The long-term oncological outcomes, expressed as OS, DFS, RFS, and recurrence rate, were similar between RG and LG. However, more randomized controlled trials with rigorous study designs and patient cohorts are needed to evaluate the oncologic outcomes of RG in patients with gastric cancer.
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Outcomes of the Learning Curve in Our First 100 Consecutive Laparoscopic Gastrectomies. Surg Laparosc Endosc Percutan Tech 2019; 29:126-132. [DOI: 10.1097/sle.0000000000000622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Liao G, Wang Z, Li H, Min J, Zhong J, Mariella S, Qian K, Zhang W. Learning curve and short-term outcomes of modularized LADG for advanced gastric cancer: A retrospective study. Medicine (Baltimore) 2019; 98:e14670. [PMID: 30855456 PMCID: PMC6417604 DOI: 10.1097/md.0000000000014670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Laparoscopy-assisted distal gastrectomy (LADG) is a complicated procedure. To reduce the difficulty of the operation and standardize the surgical procedure, we explored a new operation mode, which we termed modularized LADG (MLADG). To further extend the new operation mode, we conducted this study to evaluate the short-term outcomes of MLADG for advanced gastric cancer, and determine the learning curve.Data from 100 consecutive patients who received LADG between October 2016 and October 2017 were retrospectively analyzed. Short-term outcomes, such as operation time and intraoperative blood loss, were evaluated, and the learning curve was calculated.For MLADG, the mean operation time was 168.2 ± 13.0 minutes, the mean intraoperative blood loss was 93.6 ± 29.1 ml, the mean number of harvested lymph nodes was 28.6 ± 4.2, and conversion to open surgery occurred in only 1 case. In addition, MLADG had an acceptable postoperative complication incidence and fast postoperative recovery. After the first 20 cases, the operation skill reached a mature and stable level.Our results indicate that MLADG is an oncologically feasible and technically safe surgical procedure. For the trainees with rich experience in open distal gastrectomy, the learning curve is considered to be completed after 20 MLADG cases.
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Bobo Z, Xin W, Jiang L, Quan W, Liang B, Xiangbing D, Ziqiang W. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies. Surg Endosc 2019; 33:1033-1048. [DOI: 10.1007/s00464-018-06648-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 12/24/2018] [Indexed: 02/07/2023]
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Upper extremity surface electromyography signal changes after laparoscopic training. Wideochir Inne Tech Maloinwazyjne 2018; 13:485-493. [PMID: 30524619 PMCID: PMC6280082 DOI: 10.5114/wiitm.2018.78744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/02/2018] [Indexed: 01/28/2023] Open
Abstract
Introduction Objective measures of laparoscopic skill in training are lacking. Aim To evaluate the changes in the surface electromyography (sEMG) signal during laparoscopic training, and to link them to intracorporeal knot tying. Material and methods Ten right-handed medical students (6 female), aged 25 ±0.98, without training in laparoscopy, were enrolled in the study. With no additional training, they tied intracorporeal single knots for 15 min. Then underwent laparoscopic training and redid the knot tying exercise. During both events, sEMG was recorded from 8 measurement points on the upper extremities and neck bilaterally. We analyzed changes in sEMG resulting from training and tried to find sEMG predictive parameters for higher technical competence defined by the number of knots tied after the training. Results The average number of knots increased after the training. Significant decreases in activity after the training were visible for the non-dominant hand deltoid and trapezius muscles. Dominant and non-dominant hands had different activation patterns. Differences largely disappeared after the training. All muscles, except for the dominant forearm and non-dominant thenar, produced a negative correlation between their activities and the number of tied knots. The strongest anticorrelation occurred for the non-dominant deltoid (r = –0.863, p < 0.05). Relatively strong relationships were identified in the case of the non-dominant trapezius and forearm muscles (r = –0.587, r = –0.504). Conclusions At least for some muscle groups there is a change in activation patterns after laparoscopic training. Proximal muscle groups tend to become more relaxed and the distal ones become more active. Changes in the non-dominant hand are more pronounced than in the dominant hand.
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Learning curve of totally laparoscopic distal gastrectomy for gastric cancer: a single teaching hospital study. Wideochir Inne Tech Maloinwazyjne 2018; 13:442-447. [PMID: 30524613 PMCID: PMC6280086 DOI: 10.5114/wiitm.2018.78965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/26/2018] [Indexed: 01/28/2023] Open
Abstract
Introduction Totally laparoscopic distal gastrectomy (TLDG) for gastric cancer has gradually gained popularity. However, the learning curve of TLDG is rarely reported. Aim To determine the learning curve of TLDG for gastric cancer. Material and methods We retrospectively reviewed and analyzed the medical records of 80 patients with gastric cancer who underwent TLDG with lymph node dissection from January 2016 to December 2017. We divided the patients into four groups based on when they underwent TLDG: group A (cases 1–20), group B (cases 21–40), group C (cases 41–60), and group D (cases 61–80). Comparative analyses of clinical data, including clinicopathologic characteristics, operative data, and postoperative course, were performed for these groups. Results No significant difference was observed between the groups in various clinicopathologic characteristics. Total operative time for group A (168.3 ±14.6 min) was significantly longer than for groups B (152.5 ±10.5 min), C (154.2 ±11.6 min), and D (155.3 ±10.8 min), but there was no significant difference between groups B, C, and D. Anastomosis time for group A (27.5 ±12.4 min) was significantly longer than for groups B (15.3 ±4.6 min), C (16.6 ±5.7 min), and D (15.4 ±4.5 min), but there was no significant difference between groups B, C, and D. Non-anastomosis time, estimated blood loss, retrieved lymph nodes, time to first flatus, time to first oral intake, and postoperative hospital stay and complications showed no difference between the four groups. Conclusions An experience of approximately 20 cases of TLDG was required to complete the learning curve.
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Jiao J, Liu S, Chen C, Maimaiti A, He Q, Hu S, Yu W. Comparative study of laparoscopic radical gastrectomy and open radical gastrectomy. J Minim Access Surg 2018; 16:41-46. [PMID: 30106026 PMCID: PMC6945335 DOI: 10.4103/jmas.jmas_155_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: At present, the main treatment of gastric cancer is surgical resection combined with radiotherapy and chemotherapy, the most important part of which is radical gastrectomy. Laparoscopic radical gastrectomy for advanced gastric cancer is difficult to operate, and whether it can achieve the same curative effect with the laparotomy is still controversial. Materials and Methods: This study retrospectively analysed the clinical data of 269 gastric cancer patients surgically treated by our medical team from May 2011 to December 2015 for comparative analysis of the clinical efficacy of laparoscopic-assisted radical gastrectomy and traditional open radical gastrectomy. Results: The laparoscopic surgery group had longer duration of surgery, less intra-operative blood loss, shorter post-operative exhaust time, shorter post-operative hospital stay and shorter timing of drain removal. The average number of harvested lymph nodes in the laparoscopic surgery group was 22.9 ± 9.5 per case. And in the laparotomy group the average number was 23.3 ± 9.9 per case. The difference had no statistical significance. With the increase of the number of laparoscopic surgical procedures, the amount of intra-operative blood loss gradually decreases, and the duration of surgery is gradually reduced. Conclusion: Laparoscopic radical gastrectomy is superior to open surgery in the aspects of intra-operative blood loss, post-operative exhaust time, post-operative hospital stay and timing of drain removal. With the number of laparoscopic radical gastrectomy cases increased, the duration of surgery is shortened and the amount of intra-operative blood loss will decrease.
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Affiliation(s)
- Jie Jiao
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P.R. China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P.R. China
| | - Cheng Chen
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P.R. China
| | - A Maimaiti
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P.R. China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P.R. China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P.R. China
| | - Wenbin Yu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P.R. China
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Hikage M, Tokunaga M, Makuuchi R, Tanizawa Y, Bando E, Kawamura T, Terashima M. Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Makoto Hikage
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
- Department of Surgery, Sendai City Hospital, Miyagi, Japan
| | - Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
- Gastric Surgery Division, National Cancer Center East, Chiba, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:453-458. [DOI: 10.1097/imi.0000000000000437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective Robot-assisted gastrectomy is increasingly used for the treatment of gastric cancer, although it remains a time-consuming procedure. An ultrasonically activated device might be useful to shorten operation times. This study therefore assessed the effect of ultrasonically activated device use on procedural times and on other early surgical outcomes. Methods Consecutive patients (N = 42) who underwent robot-assisted distal gastrectomy for gastric cancer were included. Clinicopathological characteristics and early surgical outcomes were compared between robotic-assisted gastrectomy procedures using an ultrasonically activated device (U group, n = 21) and those without it (NU group, n = 21). Results There were no significant differences in patient characteristics between the groups; however, the median operation time was significantly less in the U group than in the NU group (291 vs 351 minutes, P = 0.006). In detail, the median duration of console time until dividing the duodenum was less in the U group (70 vs 102 minutes, P < 0.001). Estimated blood loss, incidence of postoperative morbidity, and duration of postoperative hospital stay were not different between the groups. Conclusions An ultrasonically activated device reduced the operation time of robot-assisted gastrectomy without increasing blood loss and morbidity.
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Chi KC, Park JM. Laparoscopic Gastrectomy Performed by an Expert in Open Gastrectomy. J Gastric Cancer 2017; 17:237-245. [PMID: 28970954 PMCID: PMC5620093 DOI: 10.5230/jgc.2017.17.e30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 01/04/2023] Open
Abstract
Purpose Senior surgeons prefer open gastrectomy (OG), while young surgeons prefer laparoscopic gastrectomy (LG). The purpose of this study was to evaluate the surgical outcomes of LG performed by a senior surgeon who was an expert in OG during his learning period, by comparing them with LGs performed by a young surgeon. Materials and Methods A senior surgeon performed 50 curative gastrectomies with laparoscopy (LG-S group) from March 2015 to August 2016. A young surgeon's initial 50 LGs comprised the LG-Y group. Clinicopathological characteristics and surgical outcomes were compared between the LG-S and LG-Y groups. Results D2 lymphadenectomy was more frequently performed in the LG-S group than in the LG-Y group (P=0.029). The operation time and number of retrieved lymph nodes did not significantly differ between the 2 surgeons (P=0.258 and P=0.410, respectively). Postoperative hospital stay and postoperative complication rate were similar between 2 groups (P=0.234 and P=1.000, respectively). Similarly, significant decreases in operation time with increasing case numbers were observed for both surgeons, whereas the number of retrieved lymph nodes increased significantly in the LG-Y group but not in the LG-S group. Conclusions The LG outcomes when performed by the senior surgeon were comparable to those when performed by the young surgeon, despite performing more extended lymphadenectomies. Senior surgeons who are experts in OG should not refrain from performing LG.
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Affiliation(s)
- Kyong-Choun Chi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joong-Min Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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42
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Chen K, Pan Y, Zhang B, Maher H, Wang XF, Cai XJ. Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg 2017; 17:93. [PMID: 28836986 PMCID: PMC5571509 DOI: 10.1186/s12893-017-0290-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 08/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Advanced minimally invasive techniques including robotic surgery are being employed with increasing frequency around the world, primarily in order to improve the surgical outcomes of laparoscopic gastrectomy (LG). We conducted a systematic review and meta-analysis to evaluate the feasibility, safety and efficacy of robotic gastrectomy (RG). Methods Studies, which compared surgical outcomes between LG and RG, were retrieved from medical databases before May 2017. Outcomes of interest were estimated as weighted mean difference (WMD) or risk ratio (RR) using the random-effects model. The software Review Manage version 5.1 was used for all calculations. Results Nineteen comparative studies with 5953 patients were included in this analysis. Compared with LG, RG was associated with longer operation time (WMD = −49.05 min; 95% CI: -58.18 ~ −39.91, P < 0.01), less intraoperative blood loss (WMD = 24.38 ml; 95% CI: 12.32 ~ 36.43, P < 0.01), earlier time to oral intake (WMD = 0.23 days; 95% CI: 0.13 ~ 0.34, P < 0.01), and a higher expense (WMD = −3944.8 USD; 95% CI: -4943.5 ~ −2946.2, P < 0.01). There was no significant difference between RG and LG regarding time to flatus, hospitalization, morbidity, mortality, harvested lymph nodes, and cancer recurrence. Conclusions RG can be performed as safely as LG. However, it will take more effort to decrease operation time and expense.
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Affiliation(s)
- Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Hendi Maher
- School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
| | - Xian-Fa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Xiu-Jun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China.
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43
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Alhossaini RM, Altamran AA, Seo WJ, Hyung WJ. Robotic gastrectomy for gastric cancer: Current evidence. Ann Gastroenterol Surg 2017; 1:82-89. [PMID: 29863139 PMCID: PMC5881341 DOI: 10.1002/ags3.12020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/16/2017] [Indexed: 12/14/2022] Open
Abstract
The robotic system has gained wide acceptance in specialties such as urological and gynecological surgery. It has also been applied in the field of upper gastrointestinal surgery. Since the first implementation of the robotic system for the treatment of gastric adenocarcinoma, the procedure has been found to be safe and feasible. Although robotic gastrectomy does not meet our expectations and yield better results than laparoscopic gastrectomy, this procedure seems to provide several advantages over laparoscopy such as reduced blood loss, shorter learning curves and increased number of retrieved lymph nodes. However, as many case series, including a recent multicenter study, have revealed, higher cost and longer operation time are the major limitations of robotic gastrectomy. Furthermore, there are no results from well-designed randomized clinical trials comparing the two procedures. New procedures in much more technically demanding cases will test the genuine benefits of robotic gastrectomy.
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Affiliation(s)
- Rana M Alhossaini
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Abdulaziz A Altamran
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Won Jun Seo
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Woo Jin Hyung
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
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Kameda C, Watanabe M, Suehara N, Watanabe Y, Nishihara K, Nakano T, Nakamura M. Safety of laparoscopic distal gastrectomy for gastric cancer when performed by trainee surgeons with little experience in performing open gastrectomy. Surg Today 2017; 48:211-216. [PMID: 28726166 DOI: 10.1007/s00595-017-1569-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/05/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to evaluate the surgical outcomes and clinical safety of laparoscopic distal gastrectomy (LDG) when performed by trainee surgeons with little prior experience in performing open gastrectomy, under the guidance of trainer surgeons. METHODS From January 2008 until March 2015, 17 trainee surgeons and 5 trainer surgeons performed LDGs to treat 371 patients with clinical stage T1-T3 gastric cancer. Of these patients, 140 and 231 underwent LDG performed by trainee surgeons and trainer surgeons, respectively. We retrospectively analyzed the surgical outcomes of the two groups. RESULTS Trainee surgeons required significantly longer operation times than the trainer surgeons, with respective mean operation times of 262 and 223 min (p < 0.001). However, the mean blood loss volumes, average numbers of retrieved lymph nodes, postoperative complications, and postoperative hospital stay lengths did not differ significantly between LDGs performed by trainee surgeons and trainer surgeons. CONCLUSIONS The study findings suggest that, under the guidance of trainer surgeons, trainee surgeons with little experience with open gastrectomy and even without prior experience with LDG can perform radical surgeries safely.
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Affiliation(s)
- Chizu Kameda
- Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan. .,Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecyou Kita-ku, Sakai, 591-8025, Japan.
| | - Masato Watanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Nobuhiro Suehara
- Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Yusuke Watanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | | | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Kuroda S, Kikuchi S, Hori N, Sakamoto S, Kagawa T, Watanabe M, Kubota T, Kuwada K, Ishida M, Kishimoto H, Uno F, Nishizaki M, Kagawa S, Fujiwara T. Training system for laparoscopy-assisted distal gastrectomy. Surg Today 2017; 47:802-809. [PMID: 27830364 PMCID: PMC5486601 DOI: 10.1007/s00595-016-1439-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/10/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE Laparoscopy-assisted distal gastrectomy (LADG) is likely to become a standard procedure for gastric cancer, which highlights the importance of establishing a training system in which even inexperienced surgeons can perform this procedure safely. This study assesses our training system for LADG based on short-term surgical outcomes. METHODS We evaluated retrospectively the short-term outcomes of 100 consecutive LADGs with curative D1/D1+ lymph node dissection. Our training system was assessed based on the learning curve of trainees, and factors related to achieving good-quality operations were analyzed statistically. RESULTS Overall, postoperative complications developed in 10 patients (10%), and included one case of anastomotic leakage (1%) and one case of pancreatic fistula (1%). The learning curve of the trainees plateaued after 10 operator cases in terms of operation time. The importance of the trainer's position was also confirmed by the result that the operation time was significantly longer when trainees with ≤10 operator cases performed LADG with a trainer as scopist vs. a trainer as the first assistant. Univariate and multivariate analyses revealed that >10 operator cases were the most important factor for achieving good-quality operations. CONCLUSION These results show that our current LADG procedure and training system are appropriate and effective.
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Affiliation(s)
- Shinji Kuroda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Satoru Kikuchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Naoto Hori
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
- Department of Surgery, Shobara Red Cross Hospital, Shobara, Japan
| | - Shuichi Sakamoto
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tetsuya Kagawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Megumi Watanabe
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
- Department of Surgery, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Tetsushi Kubota
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazuya Kuwada
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Michihiro Ishida
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroyuki Kishimoto
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Futoshi Uno
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masahiko Nishizaki
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Status and Prospects of Robotic Gastrectomy for Gastric Cancer: Our Experience and a Review of the Literature. Gastroenterol Res Pract 2017. [PMID: 28626474 PMCID: PMC5463113 DOI: 10.1155/2017/7197652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Since the first report of robotic gastrectomy, experienced laparoscopic surgeons have used surgical robots to treat gastric cancer and resolve problems associated with laparoscopic gastrectomy. However, compared with laparoscopic gastrectomy, the superiority of robotic procedures has not been clearly proven. There are several advantages to using robotic surgery for gastric cancer, such as reduced estimated blood loss during the operation, a shorter learning curve, and a larger number of examined lymph nodes than conventional laparoscopic gastrectomy. The increased operation time observed with a robotic system is decreasing because surgeons have accumulated experience using this procedure. While there is limited evidence, long-term oncologic outcomes appear to be similar between robotic and laparoscopic gastrectomy. Robotic procedures have a significantly greater financial cost than laparoscopic gastrectomy, which is a major drawback. Recent clinical studies tried to demonstrate that the benefits of robotic surgery outweighed the cost, but the overall results were disappointing. Ongoing studies are investigating the benefits of robotic gastrectomy in more complicated and challenging cases. Well-designed randomized control trials with large sample sizes are needed to investigate the benefits of robotic gastrectomy compared with laparoscopic surgery.
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Yang SY, Roh KH, Kim YN, Cho M, Lim SH, Son T, Hyung WJ, Kim HI. Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer. Ann Surg Oncol 2017; 24:1770-1777. [PMID: 28357674 DOI: 10.1245/s10434-017-5851-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND In contrast to the significant advantages of laparoscopic versus open gastrectomy, robotic gastrectomy has shown little benefit over laparoscopic gastrectomy. This study aimed to compare multi-dimensional aspects of surgical outcomes after open, laparoscopic, and robotic gastrectomy. METHODS Data from 915 gastric cancer patients who underwent gastrectomy by one surgeon between March 2009 and May 2015 were retrospectively reviewed. Perioperative parameters were analyzed for short-term outcomes. Surgical success was defined as the absence of conversion to open surgery, major complications, readmission, positive resection margin, or fewer than 16 retrieved lymph nodes. RESULTS This study investigated 241 patients undergoing open gastrectomy, 511 patients undergoing laparoscopic gastrectomy, and 173 patients undergoing robotic gastrectomy. For each approach, the respective incidences were as follows: conversion to open surgery (not applicable, 0.4%, and 0%; p = 0.444), in-hospital major complications (5.8, 2.7, and 1.2%; p = 0.020), delayed complications requiring readmission (2.9, 2.0, and 1.2%; p = 0.453), positive resection margin (1.7, 0, and 0%; p = 0.003), and inadequate number of retrieved lymph nodes (0.4, 4.1, and 1.7%; p = 0.010). Compared with open and laparoscopic surgery, robotic gastrectomy had the highest surgical success rate (90, 90.8, and 96.0%). Learning-curve analysis of success using cumulative sum plots showed success with the robotic approach from the start. Multivariate analyses identified age, sex, and gastrectomy extent as significant independent parameters affecting surgical success. Surgical approach was not a contributing factor. CONCLUSIONS Open, laparoscopic, and robotic gastrectomy exhibited different incidences and causes of surgical failure. Robotic gastrectomy produced the best surgical outcomes, although the approach method itself was not an independent factor for success.
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Affiliation(s)
- Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Kun Ho Roh
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - You-Na Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Seung Hyun Lim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. .,Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea. .,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea.
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Gholami S, Cassidy MR, Strong VE. Minimally Invasive Surgical Approaches to Gastric Resection. Surg Clin North Am 2017; 97:249-264. [PMID: 28325185 DOI: 10.1016/j.suc.2016.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Minimally invasive gastric resections carry several advantages, including less intraoperative blood loss, faster recovery time, reduced pain, and decreased hospital length of stay and quicker return to work. Numerous trials have proved that laparoscopic and robotic-assisted gastrectomy provides equivalent surgical and oncologic outcomes to open approaches. As with any minimally invasive approach, advanced minimally invasive training and good judgment by a surgeon are paramount in selecting patients in whom a minimally invasive approach is feasible. With increasing research in patient populations with more advanced disease, the indications are likely to continue to expand.
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Affiliation(s)
- Sepideh Gholami
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-1272, New York, NY 10065, USA.
| | - Michael R Cassidy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-1272, New York, NY 10065, USA
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H-1217, New York, NY 10065, USA
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Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Robotic surgery for upper gastrointestinal cancer: Current status and future perspectives. Dig Endosc 2016; 28:701-713. [PMID: 27403808 DOI: 10.1111/den.12697] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/27/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023]
Abstract
Robotic surgery with the da Vinci Surgical System has been increasingly applied in a wide range of surgical specialties, especially in urology and gynecology. However, in the field of upper gastrointestinal (GI) tract, the da Vinci Surgical System has yet to be standard as a result of a lack of clear benefits in comparison with conventional minimally invasive surgery. We have been carrying out robotic gastrectomy and esophagectomy for operable patients with resectable upper GI malignancies since 2009, and have demonstrated the potential advantages of the use of the robot in possibly reducing postoperative local complications including pancreatic fistula following gastrectomy and recurrent laryngeal nerve palsy after esophagectomy, even though there have been a couple of problems to be solved including longer duration of operation and higher cost. The present review provides updates on robotic surgery for gastric and esophageal cancer based on our experience and review of the literature.
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Affiliation(s)
- Koichi Suda
- Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
| | - Masaya Nakauchi
- Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Kazuki Inaba
- Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Yoshinori Ishida
- Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Ichiro Uyama
- Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan
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