基于倾向性评分匹配的机器人和腹腔镜胃癌根治术的近期与远期疗效比较

Comparison of the short-term and long-term outcome between robotic gastrectomy and laparoscopic gastrectomy： a propensity score matching analysis

目的比较机器人和腹腔镜胃癌根治术的近期和远期疗效。方法回顾性分析2011年12月至2013年12月在解放军总医院普通外科接受机器人或腹腔镜胃癌根治术的517例患者的临床资料，采用倾向性评分匹配法选取机器人组和腹腔镜组各70例，采用t检验、χ2检验或Fisher精确概率检验比较两组患者手术指标，采用Kaplan－Meier曲线和Log－rank检验比较总体生存情况，采用Cox回归模型进行预后因素分析。结果机器人组和腹腔镜组患者基线资料具有可比性。两组中转开腹率（5.7%比4.3%，P＝1.000），淋巴结清扫数目[（25.5±7.2）枚比（24.5±8.3）枚，t＝0.770，P＝0.443]相似，机器人组术中出血量更少[（147.0±96.8）ml比（188.0±111.2）ml，t＝－2.326，P＝0.021]，两组术后并发症（χ2＝0.233，P＝0.629）及其严重程度分级（W＝70.500，P＝0.053）相似。预后方面，两组3年生存率相似（72.9%比60.0%，P＝0.578）。性别（HR＝2.529，95% CI：1.042～6.140，P＝0.040）、新辅助化疗（HR＝0.272，95% CI：0.104～0.710，P＝0.008）和脉管癌栓（HR＝2.135，95% CI：1.027～4.438，P＝0.042）为患者总体生存时间的独立预后因素。结论机器人胃癌根治术能获得与腹腔镜胃癌根治术相当的近期与远期疗效。

ObjectiveTo compare the short-term and long-term outcome between robotic gastrectomy and laparoscopic gastrectomy.MethodsThe clinical data of 517 patients who had received robotic gastectomy and laparoscopic gastrectomy between December 2011 and December 2013 at Department of General Surgery, Chinese People′s Liberation Army General Hospital was collected. After propensity score matching, 70 patients in robotic gastectomy and 70 patients in laparoscopic gastectomy were identified. Perioperative outcome and overall survival were compared between the two groups using t test, χ2 test, Kaplan-Meier curve and Log-rank test, respectively. Prognosis factors were analyzed by Cox′s proportional hazards regression.ResultsThere were comparable baseline characteristics between patients in robotic group （RG） and those in laparoscopic group （LG）. The conversion rate for RG and LG were 5.7% and 4.3% respectively （P=1.000）. Compared with LG, RG had similar lymph node retrieval （25.5±7.2 vs. 24.5±8.3, t=0.770, P=0.443） and less blood loss （（147.0±96.8） ml vs. （188.0±111.2） ml, t=-2.326, P=0.021）. There were also similar complications （χ2=0.233, P=0.629） and severity of complications （W=70.500, P=0.053）. Although there tended to be early mobility, early flatus and less hospital stay for patients in RG group, the difference between RG and LG was not statistically significant. The 3-year survival rate was 72.9% and 60.0% for patients in RG and patients in LG （P=0.578）. Multivariable analysis revealed gender （HR=2.529, 95% CI： 1.042 to 6.140, P=0.040）, neoadjuvant chemotherapy （HR=0.272, 95% CI： 0.104 to 0.710, P=0.008） and vascular invasion （HR=2.135, 95% CI： 1.027 to 4.438, P=0.042） were independent prognostic factors.ConclusionCompared with laparoscopic gastrectomy, robotic gastectomy could achieve similar short-term and long-term outcomes.