高龄胃癌患者开腹与机器人胃癌根治术近期疗效比较分析

The comparison of the short-term outcomes between open gastrectomy and robotic gastrectomy for elderly gastric cancer patients in China

目的比较机器人及开腹胃癌根治术在高龄胃癌患者中的近期疗效,探究影响高龄胃癌术后并发症的独立危险因素。方法通过回顾性分析,收集2017年5月至2021年5月期间,于解放军总医院第一医学中心普通外科医学部,161例行开腹或机器人胃癌根治术、年龄≥70岁高龄患者的临床病例资料。两组基线资料及肿瘤病理学特征的比较,差异无统计学意义(P>0.05),具有可比性。比较两组围手术期指标,以评估近期疗效。二元Logistic回归探究影响术后并发症的独立危险因素。结果机器人组相比开腹组,手术时间显著延长[(242.92±55.12)min比(170.37±43.15)min,P<0.001]。尽管机器人组与开腹组术中估计出血量相当[100 ml(100~200)ml比100 ml(100~200)ml,P=0.102],但机器人组术中出血量(≥400 ml)的比例较开腹组显著降低(4.8%比15.4%),差异有统计学意义(P=0.025)。机器人组与开腹组在淋巴结清扫数目[(24.51±9.51)枚比(24.28±9.36)枚,P=0.881)]、术后住院时间[10.0 d(9.0~12.0)d比9.1 d(8.6~11.0)d,P=0.094]、术后总体并发症发生率(25.3%比26.9%,P=0.815)、严重并发症发生率(8.4%比3.8%,P=0.228)、吻合口漏发生率(2.4%比5.1%,P=0.363)、围手术期病死率(2.4%比1.3%,P=0.597)的差异无统计学意义。单因素及多因素分析结果显示,年龄≥80岁是影响高龄胃癌患者术后并发症发生的独立危险因素。结论在高龄胃癌患者中,行机器人胃癌根治术的近期疗效与开腹手术相当,操作安全、可行。年龄≥80岁是高龄胃癌术后并发症发生的独立危险因素,对此类患者应注重围手术期评估及术后护理,降低并发症发生率。

Objective To analyze the short-term outcomes between open and robotic gastrectomy for elderly gastric cancer patients and explore the independent factors which influenced postoperative complications after gastrectomy.Methods A retrospective study was conducted.We collected clinical data of 161 elder patients(Age over 70 years)undergoing open or robotic gastrectomy in the department of general surgery,Chinese PLA General Hospital First Medical Center between May 2017 and May 2021 were collected.The characteristics of clinicopathological datas between two groups were not significantly different(P>0.05).Results The operative time was significantly longer in the robotic group compared to the open group[(242.92±55.12)min vs.(170.37±43.15)min,P<0.001].Although intraoperative bleeding was comparable between the robotic and open groups[100 ml(100-200)ml vs.100 ml(10-200)ml,P=0.102],the proportion of bleeding≥400 ml was significantly lower in the robotic group compared with the open group(4.8%vs.15.4%),with a statistically significant difference(P=0.025).The difference between the robotic and open groups were not statistically significant in the aspect of the number of retrieved lymph nodes[(24.51±9.51)vs.(24.28±9.36),P=0.881],postoperative hospital stay[10.0 d(9.0-12.0)d vs.9.1 d(8.6-11.0)d,P=0.094],30 days postoperative complication rate(25.3%vs.26.9%,P=0.815),severe complication rate(8.4%vs.3.8%,P=0.228),anastomotic leakage rate(2.4%vs.5.1%,P=0.363),and 30 days postoperative mortality(2.4%vs.1.3%,P=0.597).Univariate and multifactorial analyses showed that age≥80 years was an independent risk factor for postoperative complications in elderly patients with gastric cancer.Conclusions Elderly patients who accepted robotic gastrectomy are safe and feasible.Over 80 years old is the independent risk factor of the postoperative complications after gastrectomy which needs to evaluate the surgical risk sufficiently.