新辅助化疗联合达芬奇机器人手术治疗进展期胃癌的安全性及短期疗效的临床研究
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国家自然科学基金(82074432);南京中医药大学自然基金(XZR2020017)


Satety and short ⁃ term efficacy of Da Vinci robotic surgery after neoadjuvant chemotherapy for locally advanced gastric cancer
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    摘要:

    目的:探讨新辅助化疗联合达芬奇机器人手术治疗进展期胃癌的安全性和可行性。方法:回顾性分析2018年7月 —2022年7月在南京中医药大学附属医院行术前新辅助化疗(SOX方案)联合腹腔镜或达芬奇机器人胃癌根治术的进展期胃癌151例,依据纳入排除标准最终纳入120例,依据手术方式分为达芬奇机器人辅助胃癌根治术组(机器人组)60例和腹腔镜下胃癌根治术组(腹腔镜组)60例,比较两组的临床资料、围手术期手术相关指标及术后康复指标。结果:两组的年龄、体重指数、肿瘤大小、肿瘤位置、手术范围、消化道重建方式、术前临床分期(cTNM分期)、病理分期(ypTNM分期)、细胞分化程度、肿瘤退缩分级、完全缓解及部分缓解情况差异无统计学意义(P>0.05)。两组手术时间、术中出血估计量、腹部切口长度差异均有统计学意义(P<0.05),而淋巴结清扫总数及转移淋巴结数目差异均无统计学意义(P>0.05)。两组术后疼痛评分、术后首次流质饮食时间、首次通气时间、腹腔引流管拔管时间及术后住院时间、住院费用差异均有统计学意义(P<0.05),并且两组术后C反应蛋白、白细胞计数、中性粒细胞计数、术后血清前白蛋白、白介素(interleukin,IL)-6、降钙素原差异也均有统计学意义 (P<0.05),而两组术后并发症发生率及术后30 d内再入院、术后30 d内二次手术情况差异均无统计学意义(P>0.05)。机器人组术中出血估计量、腹部切口长度、术后疼痛评分、术后首次流质饮食时间、术后首次通气时间、术后腹腔引流管拔除时间、 术后住院时间均优于腹腔镜组,但手术时间、住院费用明显劣于腹腔镜组。结论:进展期胃癌采取术前新辅助化疗联合达芬奇机器人手术的策略是安全可行的,其术后并发症发生率与腹腔镜胃癌手术相似,达芬奇机器人手术是进展期胃癌新的候选治疗方式。

    Abstract:

    Objective:This study aims to explore the safety and feasibility of neoadjuvant chemotherapy combined with Da Vinci robotic surgery for advanced gastric cancer. Methods:The respective cross - sectional study was conducted. There were 151 patients retrospectively analyzed,who underwent radical gastrectomy after two cycles of neoadjuvant chemotherapy(SOX)in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from July 2018 to July 2022,and 120 cases were finally included according to the inclusion and exclusion criteria. According to mode of operation,all patients were divided into Da Vinci robotic radical gastrectomy group(robot group,60 cases)and laparoscopic radical gastrectomy group(laparoscopy group,60 cases). The general data, perioperative surgery related indexes and postoperative rehabilitation were compared between two groups. Results:There was no significant difference between the two groups in age,body mass index,tumor size,tumor location,surgical scope,digestive tract reconstruction mode,preoperative clinical stage(cTNM),pathological stage(ypTNM),cell differentiation degree,tumor regression grade,complete remission and partial remission(P > 0.05). There were significant differences between the two groups in operation time,estimated intraoperative bleeding and abdominal incision length(P<0.05). There were significant differences between the two groups in postoperative pain score,the time of first fluid diet,the time of first ventilation,the time of drainage tube extubation,the time of postoperative hospitalization and the cost of hospitalization(P < 0.05). There were also significant differences in C-reactive protein, leukocyte count,neutrophil count,serum prealbumin,interleukin(IL)- 6 and procalcitonin between the two groups(P < 0.05). However,there was no significant difference in the incidence rate of postoperative complications,readmission within 30 days after surgery,and secondary surgery within 30 days after surgery between the two groups(P > 0.05). In the robot group,the estimated amount of surgical bleeding,the length of abdominal incision,the score of postoperative pain,the time of first liquid diet,the time of first ventilation,the time of extraction of abdominal drainage tube,and the time of postoperative hospitalization were better than those in the laparoscope group,but the operation time and hospitalization cost were significantly worse than those in the laparoscope group. Conclusion:For advanced gastric cancer,the strategy of preoperative neoadjuvant chemotherapy combined with Da Vinci robotic surgery is safe and feasible,and the incidence of postoperative complications is similar to laparoscopic surgery. So,Da Vinci robotic surgery system is a new candidate for advanced gastric cancer.

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刘丰铭,张群耀,方云达,王刚,沈丹丽,邵明月,魏潇,刘江,江志伟,邓正明.新辅助化疗联合达芬奇机器人手术治疗进展期胃癌的安全性及短期疗效的临床研究[J].南京医科大学学报(自然科学版),2023,(3):349-356

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  • 在线发布日期: 2023-03-11
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