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Objective:To investigate the influencing factors for the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 1 396 patients who underwent Da Vinci robotic or laparoscopic radical gastrectomy for gastric cancer in the First Affiliated Hospital of Nanchang University from December 2014 to July 2019 were collected. There were 991 males and 405 females, aged (60±11) years. Surgery using Da Vinci robotic system or laparoscopic system was completed according to patients' wishes. Cases with early gastric cancer underwent D 1+ lymphadenectomy and cases with advanced gastric cancer underwent standard D 2 lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) influencing factors for the number of lymph node harvested after radical gastrectomy for gastric cancer; (4) follow-up and survival. Follow-up using outpatient examination or telephone interview was performed to detect survival of patients up to October 2020. Measurement data with normal distribution were represented as Mean± SD. Univariate analysis was done using the chi-square test or Fisher exact probability. Multivariate analysis was performed using Logistic regression model. The survival rate was calculated by Kaplan-Meier method. Results:(1) Intraoperative situations: all the 1 396 patients underwent radical gastrectomy, including 415 cases undergoing Da Vinci robotic radical gastrectomy and 981 cases undergoing laparoscopic radical gastrectomy. Thirty-five of the 1 396 patients were converted to open surgery, including 5 cases undergoing Da Vinci robotic radical gastrectomy and 30 cases undergoing laparoscopic radical gastrectomy. Of the 1 396 patients, 983 cases underwent distal gastrectomy, 400 cases underwent total gastrectomy and 13 cases underwent proximal gastrectomy, among which 597 cases underwent Billroth Ⅰ anastomosis, 385 cases underwent Billroth Ⅱ anastomosis, 401 cases underwent Roux-en-Y anastomosis and 13 cases underwent residual stomach-esophagus anastomosis. The operation time, volume of intraoperative blood loss and cases with intraoperative blood transfusion were (221±51)minutes, (201±81)mL, 24 of 415 cases undergoing Da Vinci robotic radical gastrectomy, and (196±42)minutes, (232±76)mL, 75 of 981 cases undergoing laparoscopic radical gastrectomy, respectively. (2) Postoperative situations: the time to postoperative first flatus, time to postoperative initial liquid food intake and duration of postoperative hospital stay of the 1 396 patients were (3.0±1.0) days, (4.2±1.5) days and (9.0±3.8) days, respectively. Two hundred and ten of the 1 396 patients had postoperative complications including 170 cases with grade Ⅰ-Ⅱ complications and 40 cases with grade Ⅲ-Ⅴ complications. Eight of the 210 patients with postoperative complications died of serious complica-tions and the other 202 cases were cured after symptomatic treatment. Results of postoperative histopathological examination showed that there were 958 cases of adenocarcinoma, 220 cases of mucinous adenocarcinoma, and 218 cases of signet ring cell carcinoma. The number of lymph node harvested and the number of positive lymph node of the 1 396 patients were 26.0±8.3 and 3.6±0.9, respectively, and cases with the number of lymph node harvested ≥16 or <16 were 1 312 and 84. (3) Influencing factors for the number of lymph node harvested after radical gastrectomy for gastric cancer: results of univariate analysis showed that the operating surgeon, operation method, range of gastric resection, nerve invasion, degree of tumor invasion and tumor pathological N stage were related factors influencing the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer ( χ2=13.167, 6.029, 15.686, 5.573, 9.402, 17.139, P<0.05). Results of multivariate analysis showed that the operating surgeon, operation method, range of gastric resection and tumor pathological N stage were independent factors influencing the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer ( odds ratio=1.589, 2.018, 1.787, 0.267, 95% confidence interval as 1.221?2.068, 1.140?3.570, 1.066?2.994, 0.103?0.689, P<0.05). (4) Follow-up and survival: of the 1 396 patients, 1 256 cases were followed up for 2 to 70 months, with a median follow-up time of 27 months. The 3-year cumulative survival rate of the 1 256 cases was 70.2%. Conclusion:The operating surgeon, operation method, range of gastric resection and tumor pathological N stage are independent factors influencing the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer.
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Objective:To investigate the application value of enhanced recovery after surgery (ERAS) in totally Da Vinci robotic total gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 97 patients with gastric cancer who underwent totally Da Vinci robotic total gastrectomy in the First Affiliated Hospital of Nanchang University between January 2016 and February 2019 were collected.There were 57 males and 40 females, aged (59±10)years, with a range from 35 to 60 years. Of the 97 patients, 52 receiving perioperative management using ERAS were allocated into ERAS group, and 45 receiving traditional perioperative management were allocated into traditional group. Observation indicators: (1) intraoperative situations; (2) postoperative situations. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers, and the chi-square test was used for comparison between groups. Repeated measurement data were analyzed by ANOVA. Comparison of ordinal datas was analyzed using the Mann-Whitney U test. Results:(1) Intraoperative situations: patients in the ERAS group and traditional group underwent totally Da Vinci robotic total gastrectomy for gastric cancer successfully. Cases with Roux-en-Y anastomosis or uncut Roux-en-Y anastomosis (methods of digestive reconstruction), operation time, volume of intraoperative blood loss for the ERAS group were 25, 27, (205±28)minutes, (176±80)mL, respectively, versus 21, 24, (199±31)minutes, (182±81)mL for the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.02, t=1.00, 0.37, P>0.05). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to initial liquid food intake, time to abdominal drainage tube removal, cases with postoperative complications, the number of lymph node dissected, cases in stage Ⅰ, Ⅱ, Ⅲ of postoperative tumor staging, duration of postoperative hospital stay, hospitalization expenses were (1.85±0.29)days, (2.90±0.47)days, (2.53±0.28)days, (5.72±0.95)days, 6, 28±8, 4, 25, 23, (6.43±0.52)days, (60 222±3 888)yuan in the ERAS group and (3.04±0.39)days, (3.82±0.36)days, (4.24±0.30)days, (6.75±0.48)days, 5, (27±6)days, 3, 20, 22, (8.47±0.69)days, (64 197±3 369)yuan in the traditional group, respectively. There were significant differences in the time to first out-of-bed activities, time to first anal flatus, time to initial liquid food intake, time to abdominal drainage tube removal, duration of postoperative hospital stay and hospitalization expenses between the two groups ( t=17.19, 10.69, 29.02, 6.58, 16.57, 5.34, P<0.05). There was no significant difference in the postoperative complications, the number of lymph node dissected, or postoperative tumor staging between the two groups ( χ2=0.01, t=0.68, Z=-0.46, P>0.05). From 2 hours after anesthesia awakening to 48 hours after surgery, the visual analog pain scores were changed from 3.06±0.29 to 2.13±0.32 in the ERAS group, and from 4.11±0.74 to 3.26±0.42 in the traditional group, respectively, showing a significant difference in the changing trend between the two groups ( F=264.45, P<0.05). There was no death or readmission in the postoperative 30 days. Conclusions:ERAS applied in the totally Da Vinci robotic total gastrectomy is safe and effective, which is associated with faster gastrointestinal function recovery, shorter hospital stay, better pain control, and quicker recovery afer surgery.
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Objective@#To compare the short-term and long-term outcomes of robotic rectectomy and laparoscopic rectectomy for rectal cancer based on propensity score matching.@*Methods@#The clinical data of 106 patients who underwent robotic or laparoscopic radical resection of rectal cancer at Department of General Surgery, the First Affiliated Hospital of Nanchang University from January 2015 to December 2015 were retrospectively collected. Propensity score matching method was used to perform 1∶1 matching between robot and laparoscopic rectal cancer radical surgery. Thirty-two patients in robot group and 32 patients in laparoscopic group were successfully matched. There were 15 males and 17 females in the robotic group, aging (56.2±7.5) years, 19 males and 13 females in the laparoscopic group, aged (55.5±7.6) years. The clinical outcome of the two groups were compared using t-test or Mann-Whitney U test for continuous variables, repeated measures analysis of variance, χ2 test, Fisher exact test or Wilcoxon rank sum test for dichotomous variables. The overall survival curve was drawn by Kaplan-Meier curve and the difference of survival curve was compared by Log-rank method.@*Results@#The general data of the two groups of patients were comparable after matching. Sixty-four patients successfully completed robotic or laparoscopic operation without conversion to open surgery or perioperative death case. The total operative time, the lymph node namely No. 253 group dissection time, intraoperative blood loss, postoperative urethral catheter retention time, the serum C-reactive protein levels of 24 hours after surgery were (135.7±12.1) minutes, (11.6±2.7) minutes, (66.8±10.2) ml, 3.0(1.0) d,(50.9±7.7) μg/L, respectively, while in laparoscopic group were (124.9±23.2) minutes, (13.2±2.7) minutes, (74.8±13.9) ml, 4.0(2.0) d, (55.9±6.7) μg/L respectively. The differences were statistically significant (t=2.341, t=-2.354, t=-2.621, Z=-2.743, F=7.902, respectively, P<0.05). There were no statistical differences in separation time, numbers of retrieved lymph nodes, time to first flatus, postoperative hospital stay, postoperative complication and Clavien-Dindo classification of postoperative complications (t=0.336, t=0.714, t=-0.568, Z=-1.766, Fisher Z=-0.586, respectively, all P>0.05).@*Conclusions@#Robotic surgery not only has similar safety and feasibility but also has advantages of short-term outcomes compared with laparoscopic rectectomy for rectal cancer. The long-term outcomes were similar between two groups.
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Objective To investigate the clinical efficacy of Da Vinci robotic and laparoscopic distal gastrectomy for gastric cancer.Methods The propensity score matching and retrospective cohort study was conducted.The clinicopathological data of 171 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanchang University from January 2015 to October 2016 were collected.There were 110 males and 61 females,aged from 38 to 81 years,with a median age of 57 years.Of 171 patients,70 undergoing Da Vinci robotic distal gastrectomy for gastric cancer and 101 undergoing laparoscopic distal gastrectomy were allocated into the robotic group and laparoscopic group,respectively.Observation indicators:(1) the propensity score matching conditions and comparison of general data between the two groups after the propensity score matching;(2) intraoperative and postoperative situations;(3) situations of pathological examination;(4) follow-up.Patients were followed up by outpatient examination and telephone interview to detect severe complications and survival after discharge up to October 2018.The overall survival time was from the operation data to end of follow-up or time of death.The propensity score matching was used to perform 1 ∶ 1 matching by Empower Stats.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was done using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Mann-Whitney U test.Count data were represented as absolute number,and comparison between groups was analyzed using the chi-square test and comparison of ordinal data between groups was analyzed using the Mann-Whitney U test.The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Results (1) The propensity score matching conditions and comparison of general data between the two groups after the propensity score matching:124 of 171 patients had successful matching,including 62 in each group.The body mass index (BMI) and tumor diameter before matching were (24.2±2.4)kg/m2 and (50±13)mm in the robotic group,(25.1±2.1) kg/m2 and (45±14) mm in the laparoscopic group,showing statistically significant differences between the two groups (t =-2.676,2.045,P＜ 0.05).The BMI and tumor diameter after matching were (24.5 ± 2.3) kg/m2 and (49 ± 14) mm in the robotic group,(24.4 ± 2.2) kg/m2 and (48 ± 12) mm in the laparoscopic group,showing no statistically significant difference between the two groups (t=0.110,0.524,P＞0.05).(2) Intraoperative and postoperative situations:the total operation time,volume of intraoperative blood loss,level of C-reactive protein at day 1 postoperatively,level of C-reactive protein at day 3 postoperatively,volume of totally abdominal drainage were (147±13) minutes,(115±12)mL,(52.2±7.2)mg/L,(33.7±11.9)mg/L,353.5 mL (range,267.0-1 350.0 mL) in the robotic group,and (140± 12) minutes,(131 ± 12) mL,(58.2±7.4) mg/L,(41.1 ± 16.9) rag/L,397.0 mL (range,255.0-1 600.0 mL) in the laparoscopic group,respectively,showing statistically significant differences in the above indexes between the two groups (t =3.163,-7.814,-4.631,-2.840,Z =-4.351,P＜0.05).(3) Situations of pathological examination:patients after matching in the two groups received R0 resection,with negative duodenal margin and gastric margin.The number of lymph nodes dissected in the robotic group and laparoscopic group were 22±4 and 20±4,respectively,with a statistically significant difference between the two groups (t=2.812,P＜0.05).(4) Follow-up:124 patients after propensity score matching were followed up for 6-37 months,with a median time of 25 months.During the follow-up,no severe surgery-related complications such as obstruction of input or output loop and dumping syndrome were found in the two groups within 3 months after operation.The 2-year overall survival rate was 82.1％ and 75.2％ in the robotic and laparoscopic group,with no statistically significant difference between the two groups (x2 =0.436,P＞0.05).Conclusions Compared with laparoscopic surgery,Da Vinci robotic distal gastrectomy for gastric cancer has advantages in postoperative recovery and minimally invasion.There are similar 2-year overall survival rates in the two groups.
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Objective To compare the clinical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic repairs of gastroduodenal perforation.Methods The retrospective cohort study was conducted.The clinicopathological data of 92 patients who underwent laparoscppic repair of gastroduodenal perforation from July 2014 to December 2017 in the Ganzhou People's Hospital were collected.Forty-four patients undergoing 3D laparoscopic repair and 48 patients undergoing 2D laparoscopic repair were respectively allocated into the 3D and 2D groups.Observation indicators:(1) comparisons of intra-and post-operative recovery;(2) postoperative drug sensitivity test and pathological examination;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect complications after discharging from hospital up to August 2018.Measurement data with normal distribution were represented as x-±s and comparison between groups was analyzed using t test.Measurement data with skewed distribution were described as M (range).Comparison between groups of count data was analyzed using the chi-square test.Results (1) Comparison of intra-and post-operative recovery:92 patients underwent successfully laparoscopic gastroduodenal perforation,without conversion to open surgery or perioperative death.The operation time,time of pathological tissue extract at the perforation,time of perforation repair,volume of intraoperative blood loss and time of initial anal exsufflation were respectively (60± 8)minutes,(36± 6) seconds,(137±12)seconds,(9.0±2.2)mL,(23.8±2.8)hours in the 3D group and (70±9)minutes,(39±6) seconds,(143±14) seconds,(10.3±2.5) mL,(25.9±4.8) hours in the 2D group,with statistically significant differences between groups (t =5.795,2.779,2.215,7.740,2.570,P＜0.05).Three patients in the 3D group were complicated with pulmonary infection,localized atelectasis and delirium.Two patients in the 2D group were complicated with pulmonary infection and heart failure.Patients with complications between groups were improved by symptomatic and supporting treatment.There was no statistically significant difference in cases with postoperative complications between groups (x2 =0.010,P＞ 0.05).(2) Postoperative drug sensitivity test and pathological examination:the ascites culture of peritoneal effusion in the 2 groups was positive,and drug susceptibility results were obtained.No malignant cells at the perforation were found in pathological examination.(3) Follow-up:84 patients were followed up for 1-12 months,with a median time of 3 months.There was no related complication after discharging from hospital.Conclusion Compared with 2D laparoscopic repair of gastroduodenal perforation,3D laparoscopic repair of gastroduodenal perforation not only is safe and feasible,but also has advantages of shorter operation time,perforation repair time and time of pathological tissue extract at the perforation,less volume of intraoperative blood loss and shorter time of initial anal exsufflation.