Abstract：
BACKGROUND: Gastric cancer is the fifth most prevalent malignancy globally and the fourth major contributor to cancer-related mortality. The comparative effectiveness of robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) at different stages of gastric cancer is unclear regarding surgical and survival outcomes. We compared surgical and survival outcomes between RG and LG in early-stage (cStage I) and advanced (cStage II/III) gastric cancers to elucidate the difference in the efficacy of RG across various stages of gastric cancer.
METHODS: We identified 299 patients (LG, 170; RG, 129) with cStage II/III disease and 569 (LG, 455; RG, 114) with cStage I disease who underwent either LG or RG. Following propensity score matching for RG and LG, 118 pairs were selected for cStage II/II and 113 pairs for cStage I. Surgical and survival outcomes of LG and RG were separately compared for cStage II/III and cStage I.
RESULTS: In cStage II/III, RG showed significantly fewer intra-abdominal complications of Clavien-Dindo (C.D.) Grade ≥ III in the RG group than in the LG group (LG = 8.5 vs. RG = 1.7%, P = 0.033). Multivariate analysis identified LG as an independent risk factor for intra-abdominal complications of C.D. Grade ≥ III (OR 5.69, 95% CI 1.17-27.70, P = 0.031). However, in cStage I, no difference in surgical outcomes between LG and RG was observed. No differences were observed in survival outcomes between LG and RG in both cStage I or cStage II/III.
CONCLUSIONS: The real benefit of RG was demonstrated in surgical outcomes, especially for advanced-stage gastric cancer.
METHODS: We identified 299 patients (LG, 170; RG, 129) with cStage II/III disease and 569 (LG, 455; RG, 114) with cStage I disease who underwent either LG or RG. Following propensity score matching for RG and LG, 118 pairs were selected for cStage II/II and 113 pairs for cStage I. Surgical and survival outcomes of LG and RG were separately compared for cStage II/III and cStage I.
RESULTS: In cStage II/III, RG showed significantly fewer intra-abdominal complications of Clavien-Dindo (C.D.) Grade ≥ III in the RG group than in the LG group (LG = 8.5 vs. RG = 1.7%, P = 0.033). Multivariate analysis identified LG as an independent risk factor for intra-abdominal complications of C.D. Grade ≥ III (OR 5.69, 95% CI 1.17-27.70, P = 0.031). However, in cStage I, no difference in surgical outcomes between LG and RG was observed. No differences were observed in survival outcomes between LG and RG in both cStage I or cStage II/III.
CONCLUSIONS: The real benefit of RG was demonstrated in surgical outcomes, especially for advanced-stage gastric cancer.
摘要：
背景：胃癌是全球第五大恶性肿瘤，也是癌症相关死亡率的第四大主要因素。在胃癌的不同阶段，机器人胃切除术（RG）与腹腔镜胃切除术（LG）的比较效果尚不清楚。我们比较了RG和LG在早期（cStageI）和晚期（cStageII/III）胃癌中的手术和生存结果，以阐明RG在胃癌各个阶段的疗效差异。
方法：我们确定了299例患者(LG，170;RG,129)患有cII/III期疾病和569(LG，455;RG,114)患有cStageI疾病，接受LG或RG治疗。在RG和LG的倾向得分匹配之后，选择118对进行cStageII/II，选择113对进行cStageI。分别比较了cStageII/III和cStageI的LG和RG的手术和生存结果。
结果：在cStageII/III中，RG组Clavien-Dindo（C.D.）≥III级的腹腔内并发症明显少于LG组（LG=8.5vs.RG=1.7%，P=0.033)。多因素分析确定LG是C.D.Grade≥III的腹腔内并发症的独立危险因素（OR5.69，95％CI1.17-27.70，P=0.031）。然而,在cStageI中，LG和RG的手术结局无差异.在cStageI或cStageII/III中，LG和RG之间的生存结果均未观察到差异。
结论：手术结果证明了RG的真正益处，尤其是晚期胃癌.
方法：我们确定了299例患者(LG，170;RG,129)患有cII/III期疾病和569(LG，455;RG,114)患有cStageI疾病，接受LG或RG治疗。在RG和LG的倾向得分匹配之后，选择118对进行cStageII/II，选择113对进行cStageI。分别比较了cStageII/III和cStageI的LG和RG的手术和生存结果。
结果：在cStageII/III中，RG组Clavien-Dindo（C.D.）≥III级的腹腔内并发症明显少于LG组（LG=8.5vs.RG=1.7%，P=0.033)。多因素分析确定LG是C.D.Grade≥III的腹腔内并发症的独立危险因素（OR5.69，95％CI1.17-27.70，P=0.031）。然而,在cStageI中，LG和RG的手术结局无差异.在cStageI或cStageII/III中，LG和RG之间的生存结果均未观察到差异。
结论：手术结果证明了RG的真正益处，尤其是晚期胃癌.
