新辅助治疗对胃癌病人行机器人全胃切除术近期疗效影响

Comparison of short-term efficacy of robotic total gastrectomy after neoadjuvant therapy versus robotic total gastrectomy alone for gastric cancer

目的比较胃癌病人行单纯机器人全胃切除术(robotic total gastrectomy,RTG)与新辅助治疗后机器人全胃切除术(neoadjuvant therapy-robotic total gastrectomy,NAT-RTG)的近期疗效,探究采用新辅助治疗与否对RTG术后并发症的影响。方法回顾性分析2017年4月至2022年10月期间于解放军总医院第一医学中心普通外科医学部接受RTG的146例病人临床与病理信息,其中NAT-RTG组43例,单纯RTG组103例。比较两组病人围手术期指标与术后并发症情况,并采用二元Logistic回归分析RTG术后并发症的危险因素。结果与单纯RTG组相比,NAT-RTG组术后住院时间显著延长,差异有统计学意义[12.0(10.0,15.0)d比10.0(9.0,13.0)d,P=0.036]。NAT-RTG组与单纯RTG组以下指标比较差异均无统计学意义:手术时间[(279.0±56.0)min比(270.4±57.7)min,P=0.407],术中出血量[200(100,200)mL比100(100,200)mL,P=0.422],肿瘤R0切除率(90.7%比95.1%,P=0.308),淋巴结清扫数目[(26.2±12.3)个比(30.0±13.3)个,P=0.108],术后首次肛门排气时间[5.0(3.0,6.0)d比4.0(4.0,5.0)d,P=0.171],手术费用[(6.96±1.04)万元比(6.95±1.07)万元,P=0.984]及住院费用[(14.79±3.56)万元比(14.70±5.00)万元,P=0.908]。术后并发症方面,NAT-RTG组相比于单纯RTG组术后总体并发症发生率较高(34.9%比21.4%),但差异无统计学意义(P=0.087);在严重并发症发生率方面,NAT-RTG与RTG组差异无统计学意义(2.3%比3.9%,P=1.000)。单因素与多因素分析结果表明,女性[OR=4.019,95%CI(1.605,10.062),P=0.003]以及肿瘤长径≥3 cm[OR=3.121,95%CI(1.021,9.536),P=0.046]是影响RTG病人术后并发症发生的独立危险因素(P<0.05)。新辅助治疗不是影响RTG术后并发症的独立危险因素[OR=2.204,95%CI(0.912,5.325),P=0.079]。结论NAT-RTG与单纯行RTG近期疗效相当,但由于NAT-RTG仍有潜在增加术后并发症的风险,建议进行充分的术前评估与优化围手术期诊疗决策。此外,对于女性、肿瘤长径≥3 cm且需行RTG的病人,应重视术前筛查与评估,以减少围手术期并发症发生可能。

Objective To compare the short-term outcomes of robotic total gastrectomy(RTG)alone versus neoadjuvant therapy-robotic total gastrectomy(NAT-RTG)and explore the effect of NAT on postoperative complications of RTG.Methods From April 2017 to October 2022,retrospective review was conducted for clinicopathological data of 146 patients undergoing RTG.They were assigned into two groups of NAT-RTG(n=43)and RTG(n=103).No significant inter-group differences existed in clinicopathological characteristics.The relevant perioperative parameters and postoperative complications were compared between two groups.And the risk factors of postoperative complications after RTG were examined by binary Logistic regression.Results As compared with RTG,NAT-RTG group had longer postoperative hospitalization stay[12.0(10.0-15.0)vs.10.0(9.0-13.0)day,P=0.036].There was significant difference.Operative duration[(279.0±56.0)vs.(270.4±57.7)min,P=0.407],intraoperative blood loss[200(100-200)vs.100(100-200)mL,P=0.422],R0 resection rate(90.7%vs.95.1%,P=0.308),count of retrieved lymph node[(26.2±12.3)vs.(30.0±13.3),P=0.108],initial flatus time[5.0(3.0-6.0)vs.4.0(4.0-5.0)day,P=0.171],surgical expenditure[(69.6±10.4)vs.(69.5±10.7)thousand RMB,P=0.984]and hospitalization expenditure[(147.9±35.6)vs.(147.0±50.0)thousand RMB,P=0.908]were not significantly different between NAT-RTG and RTG groups.Meanwhile,no significant difference existed in postoperative overall morbidity(34.9%vs.21.4%,P=0.087)or severe morbidity(2.3%vs.3.9%,P=1.000).Univariate and multivariate binary Logistic analyses revealed that females[OR(95%CI):4.019(1.605-10.062),P=0.003]and tumor diameter≥3 cm[OR(95%CI):3.121(1.021-9.536),P=0.046]rather than NAT[OR(95%CI):2.204(0.912-5.325),P=0.079]were the independent risk factors for postoperative complication after RTG.Conclusion NAT-RTG and RTG alone have comparable short-term outcomes.However,surgeons should pay greater attention to preoperative evaluations and optimize perioperative decision-making because of potential postoperative complications in NAT-RTG.Meanwhile,preoperative screening and evaluations are essential for female RTG patients or tumor diameter≥3 cm.