Appraisal of surgical outcomes and oncological efficiency of intraoperative adverse events in robotic radical gastrectomy for gastric cancer.
Surg Endosc
; 38(4): 2027-2040, 2024 Apr.
Article
em En
| MEDLINE
| ID: mdl-38424283
ABSTRACT
BACKGROUND:
Surgical quality control is a crucial determinant of evaluating the tumor efficacy.OBJECTIVE:
To assess the ClassIntra grade for quality control and oncological outcomes of robotic radical surgery for gastric cancer (GC).METHODS:
Data of patients undergoing robotic radical surgery for GC at a high-volume center were retrospectively analyzed. Patients were categorized into two groups, the intraoperative adverse event (iAE) group and the non-iAE group, based on the occurrence of intraoperative adverse events. The iAEs were further classified into five sublevels (ranging from I to V according to severity) based on the ClassIntra grade. Surgical performance was assessed using the Objective Structured Assessment of Technical Skill (OSATS) and the General Error Reporting Tool.RESULTS:
This study included 366 patients (iAE group n = 72 [19.7%] and non-iAE group n = 294 [80.3%]). The proportion of ClassIntra grade II patients was the highest in the iAE group (54.2%). In total and distal gastrectomies, iAEs occurred most frequently in the suprapancreatic area (50.0% and 54.8%, respectively). In total gastrectomy, grade IV iAEs were most common during lymph node dissection in the splenic hilum area (once for bleeding [grade IV] and once for injury [grade IV]). The overall survival (OS) and disease-free survival of the non-iAE group were significantly better than those of the iAE group (Log rank P < 0.001). Uni- and multi-variate analyses showed that iAEs were key prognostic indicators, independent of tumor stage and adjuvant chemotherapy (P < 0.001).CONCLUSION:
iAEs in patients who underwent robotic radical gastrectomy significantly correlated with the occurrence of postoperative complications and a poor long-term prognosis. Therefore, utilization and inclusion of ClassIntra grading as a crucial surgical quality control and prognostic indicator in the routine surgical quality evaluation system are recommended.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Gástricas
/
Procedimentos Cirúrgicos Robóticos
Limite:
Humans
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article