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Yu X, Lei W, Zhu L, Qi F, Liu Y, Feng Q. Robotic versus laparoscopic distal gastrectomy for gastric cancer: A systematic review and meta-analysis. Asian J Surg 2024:S1015-9584(24)01268-5. [PMID: 38942631 DOI: 10.1016/j.asjsur.2024.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/19/2023] [Accepted: 06/19/2024] [Indexed: 06/30/2024] Open
Abstract
Distal gastrectomy (DG) with lymph node dissection for gastric cancer is routinely performed. In this meta-analysis, we present an updated overview of the perioperative and oncological outcomes of laparoscopic DG (LDG) and robotic DG (RDG) to compare their safety and overall outcomes in patients undergoing DG. An extensive search was conducted using the MEDLINE, EMBASE, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials from the establishment of the database to June 2023 for randomized clinical trials comparing RDG and LDG. The primary outcome was operative results, postoperative recovery, complications, adequacy of resection, and long-term survival. We identified twenty studies, evaluating 5,447 patients (1,968 and 3,479 patients treated with RDG and LDG, respectively). We observed no significant differences between the two groups in terms of the proximal resection margin, number of dissected lymph nodes, major complications, anastomosis site leakage, time to first flatus, and length of hospital stay. The RDG group had a longer operative time (P < 0.00001), lesser bleeding (P = 0.0001), longer distal resection margin (P = 0.02), earlier time to oral intake (P = 0.02), fewer overall complications (P = 0.004), and higher costs (P < 0.0001) than the LDG group. RDG is a promising approach for improving LDG owing to acceptable complications and the possibility of radical resection. Longer operative times and higher costs should not prevent researchers from exploring new applications of robotic surgery.
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Affiliation(s)
- Xianzhe Yu
- Department of Gastrointestinal Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan Province, People's Republic of China; Lung Cancer Center, Lung Cancer Institute, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Wenyi Lei
- Department of Dermatology, The Second People's Hospital of Guiyang, Guiyang, Guizhou Province, People's Republic of China
| | - Lingling Zhu
- Lung Cancer Center, Lung Cancer Institute, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Fan Qi
- Department of Intensive Care Unit, The Second People's Hospital of Guiyang, Guiyang, Guizhou Province, People's Republic of China
| | - Yanyang Liu
- Lung Cancer Center, Lung Cancer Institute, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
| | - Qingbo Feng
- Department of General Surgery, Affiliated Hospital of Zunyi Medical University, Affiliated Digestive Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China.
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Meng C, Cao S, Liu X, Li L, He Q, Xia L, Jiang L, Chu X, Wang X, Wang H, Hui X, Sun Z, Huang S, Duan Q, Yang D, Zhang H, Tian Y, Li Z, Zhou Y. Effect of preoperative CT angiography examination on the clinical outcome of patients with BMI ≥ 25.0 kg/m 2 undergoing laparoscopic gastrectomy: study protocol for a multicentre randomized controlled trial. Trials 2021; 22:912. [PMID: 34895320 PMCID: PMC8666026 DOI: 10.1186/s13063-021-05887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric cancer, which is the fifth most common malignancy and the third most common cause of cancer-related death, is particularly predominant in East Asian countries, such as China, Japan and Korea. It is a serious global health issue that causes a heavy financial burden for the government and family. To our knowledge, there are few reports of multicentre randomized controlled trials on the utilization of CT angiography (CTA) for patients who are histologically diagnosed with gastric cancer before surgery. Therefore, we planned this RCT to verify whether the utilization of CTA can change the short- and long-term clinical outcomes. METHOD The GISSG 20-01 study is a multicentre, prospective, open-label clinical study that emphasises the application of CTA for patients who will undergo laparoscopic gastrectomy to prove its clinical findings. A total of 382 patients who meet the inclusion criteria will be recruited for the study and randomly divided into two groups in a 1:1 ratio: the CTA group (n = 191) and the non-CTA group (n = 191). Both groups will undergo upper abdomen enhanced CT, and the CTA group will also receive CT angiography. The primary endpoint of this trial is the volume of blood loss. The second primary endpoints are the number of retrieved lymph nodes, postoperative recovery course, hospitalization costs, length of hospitalization days, postoperative complications, 3-year OS and 3-year DFS. DISCUSSION It is anticipated that the results of this trial will provide high-level evidence and have clinical value for the application of CTA in laparoscopic gastrectomy. TRIAL REGISTRATION ClinicalTrials.gov , NCT04636099. Registered November 19, 2020.
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Affiliation(s)
- Cheng Meng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Qingsi He
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lijian Xia
- Department of Gastrointestinal Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Xianqun Chu
- Department of Gastrointestinal Surgery, Jining No.1 People's Hospital, Jining, China
| | - Xinjian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Wang
- Department of Gastrointestinal Surgery, Dongying People's Hospital, Dongying, China
| | - Xizeng Hui
- Department of Gastrointestinal Surgery, Rizhao People's Hospital, Rizhao, China
| | - Zuocheng Sun
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - Shusheng Huang
- Department of Gastrointestinal Surgery, People's Hospital of Jimo District, Qingdao, China
| | - Quanhong Duan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Daogui Yang
- Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China.
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Wei Y, Ye Z, Shang N, Yang C, Liao M, Pan Y. Congenital Visceral Vascular Variation Causing Gastrointestinal Hemorrhage: A Case Report. Front Pediatr 2021; 9:772529. [PMID: 34869125 PMCID: PMC8639160 DOI: 10.3389/fped.2021.772529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Variations in the visceral vasculature are often encountered, but rarely cause clinical symptoms. We report a 12-year-old girl with portal hypertension caused by congenital variations in visceral vessels. The clinical manifestations included gastrointestinal hemorrhage and ascites. The common hepatic artery and splenic artery stem shared the same trunk from the aorta, and the common hepatic artery was directly connected with the main portal vein to form an arteriovenous fistula. In addition, the left hepatic artery and the left gastric artery shared a common trunk termed the "hepatic-gastric trunk" which originated from the anterior wall of the aorta, while the right hepatic artery originated from the superior mesenteric artery and supplied the right liver. The patient was treated with interventional embolization and remained in good condition throughout the follow-up and at the time of publication.
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Affiliation(s)
- Yingli Wei
- Department of Diagnosis Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhiqiu Ye
- Department of Invasive Technology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ning Shang
- Department of Diagnosis Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Chaoxiang Yang
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Minyan Liao
- Department of Diagnosis Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yunxiang Pan
- Department of Diagnosis Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
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Luo R, Liu D, Ye S, Tang H, Zhu W, He P, Tang C, Li T. Short- and long-term outcomes of totally robotic versus robotic-assisted radical distal gastrectomy for advanced gastric cancer: a mono-institution retrospective study. World J Surg Oncol 2019; 17:188. [PMID: 31711530 PMCID: PMC6849191 DOI: 10.1186/s12957-019-1722-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/09/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose By comparing short- and long-term outcomes following totally robotic radical distal gastrectomy (TRDG) and robotic-assisted radical distal gastrectomy (RADG), we aimed to assess in which modus operandi patients will benefit more. Methods From January 2015 to May 2019, we included 332 patients undergone RADG (237) and TRDG (95). Based on the propensity score matching (PSM), inclusion and exclusion criteria, 246 patients were finally included in the propensity score-matched cohort including RADG group (164) and TRDG group (82). We then compared the short- and long-term outcomes following both groups. Results Propensity score-matched cohort revealed no significant differences in both groups. Intra-abdominal bleeding, time to pass flatus, postoperative activity time, length of incision hospital stays, and stress response were significantly less in TRDG group than in RADG group. We observed 30 complications in RADG group while 13 complications in TRDG group. There were no significant differences in TRDG group and RADG group in terms of operation time, time for anastomosis, proximal resection, distal resection margin, number of lymph node resection, and total hospitalization cost. Both 3-year overall survival and 3-year disease-free survival were comparable in both groups. Conclusions TRDG is a safe and feasible modus operandi profiting from short- and long-term outcomes compared with RADG. As surgeons improving their professional skills, TRDG could serve as the standard procedure for distal locally advanced gastric cancer with D2 lymphadenectomy.
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Affiliation(s)
- Rui Luo
- Medical College of Nanchang University, Nanchang, 330000, China
| | - Dongning Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Shanping Ye
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Hechun Tang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Weiquan Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Penghui He
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Cheng Tang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Taiyuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
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