Clinical effect report of 200 cases of Da Vinci robotic radical gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TIAN Yun ^1,2 , WANG Hailin ^1,2 , DUAN Guanghui ^1,2 ,  LIU Hongbin ²

1. Graduate School of Ningxia Medical University, Yinchuan 750004, R. P. China;
2. Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, R. P. China;

Corresponding author：

LIU Hongbin, Email: liuhongbin999@163.com

Keywords：

Da Vinci robot; gastric cancer; radical operation

DOI：

10.7507/1007-9424.202001004

Video：

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Objective To summarize the clinical effect of Da Vinci robot radical gastrectomy for gastric cancer.Methods A retrospective analysis was performed on 200 patients undergoing radical surgery for Da Vinci robotic gastric cancer from the General Surgery of the 940th Hospital of the Chinese People's Liberation Army from December 2016 to January 2018.Results There were 200 cases of robotic radical gastric cancer, 99 cases of radical distal gastrectomy, and 101 cases of radical total gastrectomy. The operative time was (241.0±33.3) min, intraoperative blood loss was (146.2±110.4) mL, and the number of lymph nodes cleaned was (42±14). The time of first anal exhaustion was (3.1±0.7) d, the time of first meal was (4.3±0.7) d, the postoperative extubation time was (5.3±0.5) d, and the postoperative hospitalization cost was (96 366.50±16 992.87) yuan. Tumor diameter was (4.5±2.0) cm. The degree of tumor differentiation was high differentiation in 7 cases, moderate differentiation in 61 cases and poor differentiation in 132 cases. TNM stage was 1 case in stage Ⅰ, 62 cases in stage Ⅱ and 137 cases in stage Ⅲ. Iauren was divided into intestinal type (78 cases), diffuse type (65 cases) and mixed type (57 cases). The tumor infiltrated into submucosa in 1 case, intrinsic muscularis in 3 cases, subserosal layer in 31 cases and serosal layer in 165 cases. The tumors were located in the upper part of the stomach in 45 cases, the lower part of the stomach in 106 cases, the body of the stomach in 46 cases, the whole stomach in 1 case, and the gastroesophageal junction in 2 cases. Postoperative complications occurred in 8 cases (4%), including anastomotic leakage in 4 cases, duodenal stump fistula in 1 case, tracheoesophageal fistula in 1 case, pulmonary infection in 1 case, and gastroparesis in 1 case.Conclusion The DaVinci robotic surgical system has less surgical injuries, quicker postoperative recovery, and better clinical efficacy.

Citation： TIAN Yun, WANG Hailin, DUAN Guanghui, LIU Hongbin. Clinical effect report of 200 cases of Da Vinci robotic radical gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1221-1225. doi: 10.7507/1007-9424.202001004 Copy

1.	Ferlay J, Soerjomataram I, Dikshit R, <italic>et al</italic>. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): e359-e386.
2.	Chen W, Zheng R, Baade PD, <italic>et al</italic>. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3.	Feng RM, Zong YN, Cao SM, <italic>et al</italic>. Current cancer situation in China: good or bad news from the 2018 Global Cancer Statistics? Cancer Commun (Lond), 2019, 39(1): 22.
4.	Pasechnikov V, Chukov S, Fedorov E, <italic>et al</italic>. Gastric cancer: prevention, screening and early diagnosis. World J Gastroenterol, 2014, 20(38): 13842-13862.
5.	Yang K, Lu ZH, Zhang WH, <italic>et al</italic>. Comparisons between different procedures of no. 10 lymphadenectomy for gastric cancer patients with total gastrectomy. Medicine (Baltimore), 2015, 94(33): e1305.
6.	Etoh T, Inomata M, Shiraishi N, <italic>et al</italic>. Minimally invasive approaches for gastric cancer-Japanese experiences. J Surg Oncol, 2013, 107(3): 282-288.
7.	中国研究型医院学会机器人与腹腔镜外科专业委员会. 机器人胃癌手术专家共识 (2015 版). 中国研究型医院, 2016, 15(1): 7-11.
8.	胡祥. 日本第 15 版《胃癌处理规约》及第 5 版《胃癌治疗指南》更新内容解读. 中国实用外科杂志, 2017, 37(4): 394-398.
9.	In H, Solsky I, Palis B, <italic>et al</italic>. Validation of the 8th Edition of the AJCC TNM Staging System for gastric cancer using the National Cancer Database. Ann Surg Oncol, 2017, 24(12): 3683-3691.
10.	Lu J, Zheng CH, Cao LL, <italic>et al</italic>. The effectiveness of the 8th American Joint Committee on Cancer TNM classification in the prognosis evaluation of gastric cancer patients: A comparative study between the 7th and 8th editions. Eur J Surg Oncol, 2017, 43(12): 2349-2356.
11.	杨文艳, 马艳梅, 周立霞. 老年胃癌根治术后患者发生胃瘫综合征的危险因素及预防研究. 西北国防医学杂志, 2019, 40(11): 672-676.
12.	Viñuela EF, Gonen M, Brennan MF,, <italic>et al</italic>. Laparoscopic <italic>versus</italic> open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg, 2012, 255(3): 446-456.
13.	Giulianotti PC, Coratti A, Angelini M, <italic>et al</italic>. Robotics in general surgery: personal experience in a large community hospital. Arch Surg, 2003, (7): 777-784.
14.	Hashizume M, Shimada M, Tomikawa M, <italic>et al</italic>. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc, 2002, 16(8): 1187-1191.
15.	Kim HI, Park MS, Song KJ, <italic>et al</italic>. Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg Oncol, 2014, 40(10): 1346-1354.
16.	Park SS, Kim MC, Park MS, <italic>et al</italic>. Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc, 2012, 26(1): 60-67.
17.	Zhou J, Shi Y, Qian F, <italic>et al</italic>. Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol, 2015, 111(6): 760-767.
18.	钱锋, 孙刚, 唐波, 等. 腹腔镜胃癌根治手术的学习曲线. 中国微创外科杂志, 2008, 8(6): 510-512.
19.	Jin SH, Kim DY, Kim H, <italic>et al</italic>. Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc, 2007, 21(1): 28-33.
20.	Fedorov AV, Kriger AG, Berelavichus SV, <italic>et al</italic>. Robotic-assisted abdominal surgery. Khirurgiia (Mosk), 2010, 1: 16-21.
21.	余佩武, 郝迎学. 机器人优于 2D 和 3D 腹腔镜. 中华胃肠外科杂志, 2015, 18(8): 767-768.
22.	Li Z, Li J, Li B, <italic>et al</italic>. Robotic <italic>versus</italic> laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis. Cancer Manag Res, 2018, 10: 705-714.
23.	Pan HF, Wang G, Liu J, <italic>et al</italic>. Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer. Surg Laparosc Endosc Percutan Tech, 2017, 27(6): 428-433.
24.	Cianchi F, Indennitate G, Trallori G, <italic>et al</italic>. Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study. BMC Surgery, 2016, 16(1): 65.
25.	Son T, Lee JH, Kim YM, <italic>et al</italic>. Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc, 2014, 28(9): 2606-2615.
26.	Lee J, Kim YM, Woo Y, <italic>et al</italic>. Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc, 2015, 29(11): 3251-3260.
27.	Shi Y, Xu X, Zhao Y, <italic>et al</italic>. Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic <italic>versus</italic> open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc, 2018, 32(5): 2427-2433.
28.	李爱民, 李进华, 李建民, 等. 国产机器人妙手 S 系统远程手术实验研究. 腹部外科, 2016, 29(6): 473-477.
29.	Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc, 2010, 24(3): 610-615.
30.	Anderson C, Hellan M, Kernstine K, <italic>et al</italic>. Robotic surgery for gastrointestinal malignancies. Int J Med Robot, 2007, 3(4): 297-300.
31.	金振宇. 中国达芬奇手术机器人临床应用. 中国医疗器械杂志, 2014, 38(1): 47-49.

1. Ferlay J, Soerjomataram I, Dikshit R, <italic>et al</italic>. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): e359-e386.
2. Chen W, Zheng R, Baade PD, <italic>et al</italic>. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. Feng RM, Zong YN, Cao SM, <italic>et al</italic>. Current cancer situation in China: good or bad news from the 2018 Global Cancer Statistics? Cancer Commun (Lond), 2019, 39(1): 22.
4. Pasechnikov V, Chukov S, Fedorov E, <italic>et al</italic>. Gastric cancer: prevention, screening and early diagnosis. World J Gastroenterol, 2014, 20(38): 13842-13862.
5. Yang K, Lu ZH, Zhang WH, <italic>et al</italic>. Comparisons between different procedures of no. 10 lymphadenectomy for gastric cancer patients with total gastrectomy. Medicine (Baltimore), 2015, 94(33): e1305.
6. Etoh T, Inomata M, Shiraishi N, <italic>et al</italic>. Minimally invasive approaches for gastric cancer-Japanese experiences. J Surg Oncol, 2013, 107(3): 282-288.
7. 中国研究型医院学会机器人与腹腔镜外科专业委员会. 机器人胃癌手术专家共识 (2015 版). 中国研究型医院, 2016, 15(1): 7-11.
8. 胡祥. 日本第 15 版《胃癌处理规约》及第 5 版《胃癌治疗指南》更新内容解读. 中国实用外科杂志, 2017, 37(4): 394-398.
9. In H, Solsky I, Palis B, <italic>et al</italic>. Validation of the 8th Edition of the AJCC TNM Staging System for gastric cancer using the National Cancer Database. Ann Surg Oncol, 2017, 24(12): 3683-3691.
10. Lu J, Zheng CH, Cao LL, <italic>et al</italic>. The effectiveness of the 8th American Joint Committee on Cancer TNM classification in the prognosis evaluation of gastric cancer patients: A comparative study between the 7th and 8th editions. Eur J Surg Oncol, 2017, 43(12): 2349-2356.
11. 杨文艳, 马艳梅, 周立霞. 老年胃癌根治术后患者发生胃瘫综合征的危险因素及预防研究. 西北国防医学杂志, 2019, 40(11): 672-676.
12. Viñuela EF, Gonen M, Brennan MF,, <italic>et al</italic>. Laparoscopic <italic>versus</italic> open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg, 2012, 255(3): 446-456.
13. Giulianotti PC, Coratti A, Angelini M, <italic>et al</italic>. Robotics in general surgery: personal experience in a large community hospital. Arch Surg, 2003, (7): 777-784.
14. Hashizume M, Shimada M, Tomikawa M, <italic>et al</italic>. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc, 2002, 16(8): 1187-1191.
15. Kim HI, Park MS, Song KJ, <italic>et al</italic>. Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg Oncol, 2014, 40(10): 1346-1354.
16. Park SS, Kim MC, Park MS, <italic>et al</italic>. Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc, 2012, 26(1): 60-67.
17. Zhou J, Shi Y, Qian F, <italic>et al</italic>. Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol, 2015, 111(6): 760-767.
18. 钱锋, 孙刚, 唐波, 等. 腹腔镜胃癌根治手术的学习曲线. 中国微创外科杂志, 2008, 8(6): 510-512.
19. Jin SH, Kim DY, Kim H, <italic>et al</italic>. Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc, 2007, 21(1): 28-33.
20. Fedorov AV, Kriger AG, Berelavichus SV, <italic>et al</italic>. Robotic-assisted abdominal surgery. Khirurgiia (Mosk), 2010, 1: 16-21.
21. 余佩武, 郝迎学. 机器人优于 2D 和 3D 腹腔镜. 中华胃肠外科杂志, 2015, 18(8): 767-768.
22. Li Z, Li J, Li B, <italic>et al</italic>. Robotic <italic>versus</italic> laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis. Cancer Manag Res, 2018, 10: 705-714.
23. Pan HF, Wang G, Liu J, <italic>et al</italic>. Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer. Surg Laparosc Endosc Percutan Tech, 2017, 27(6): 428-433.
24. Cianchi F, Indennitate G, Trallori G, <italic>et al</italic>. Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study. BMC Surgery, 2016, 16(1): 65.
25. Son T, Lee JH, Kim YM, <italic>et al</italic>. Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc, 2014, 28(9): 2606-2615.
26. Lee J, Kim YM, Woo Y, <italic>et al</italic>. Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc, 2015, 29(11): 3251-3260.
27. Shi Y, Xu X, Zhao Y, <italic>et al</italic>. Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic <italic>versus</italic> open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc, 2018, 32(5): 2427-2433.
28. 李爱民, 李进华, 李建民, 等. 国产机器人妙手 S 系统远程手术实验研究. 腹部外科, 2016, 29(6): 473-477.
29. Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc, 2010, 24(3): 610-615.
30. Anderson C, Hellan M, Kernstine K, <italic>et al</italic>. Robotic surgery for gastrointestinal malignancies. Int J Med Robot, 2007, 3(4): 297-300.
31. 金振宇. 中国达芬奇手术机器人临床应用. 中国医疗器械杂志, 2014, 38(1): 47-49.

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Clinical effect report of 200 cases of Da Vinci robotic radical gastrectomy

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