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中华腔镜外科杂志(电子版) ›› 2022, Vol. 15 ›› Issue (03) : 156 -162. doi: 10.3877/cma.j.issn.1674-6899.2022.03.008

论著

高龄胃癌患者开腹与机器人胃癌根治术近期疗效比较分析
彭飞1, 黄俊2, 崔昊2, 曹博3, 邓欢3, 刘贵宾2, 宋立强2, 赵瑞阳3, 李航航3, 陈凛3, 卫勃3, 王宁3,()   
  1. 1. 404399 重庆市忠县人民医院胃肠烧伤外科
    2. 100853 北京,解放军总医院第一医学中心普通外科医学部,全军普通外科研究所;300071 天津,南开大学医学院
    3. 100853 北京,解放军总医院第一医学中心普通外科医学部,全军普通外科研究所
  • 收稿日期:2022-01-21 出版日期:2022-06-30
  • 通信作者: 王宁
  • 基金资助:
    国家重点研发计划课题(2019YFB1311505); 国家自然科学基金(81773135,82073192)

The comparison of the short-term outcomes between open gastrectomy and robotic gastrectomy for elderly gastric cancer patients in China

Fei Peng1, Jun Huang2, Hao Cui2, Bo Cao3, Huan Deng3, Guibin Liu2, Liqiang Song2, Ruiyang Zhao3, Hanghang Li3, Lin Chen3, Bo Wei3, Ning Wang3,()   

  1. 1. Department of General Surgery, Zhongxian People’s Hospital of Chongqing, Chongqing 404399, China.
    2. Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing 100853, China.; School of Medicine, Nankai University, Tianjin 300071, China
    3. Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing 100853, China.
  • Received:2022-01-21 Published:2022-06-30
  • Corresponding author: Ning Wang
引用本文:

彭飞, 黄俊, 崔昊, 曹博, 邓欢, 刘贵宾, 宋立强, 赵瑞阳, 李航航, 陈凛, 卫勃, 王宁. 高龄胃癌患者开腹与机器人胃癌根治术近期疗效比较分析[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(03): 156-162.

Fei Peng, Jun Huang, Hao Cui, Bo Cao, Huan Deng, Guibin Liu, Liqiang Song, Ruiyang Zhao, Hanghang Li, Lin Chen, Bo Wei, Ning Wang. The comparison of the short-term outcomes between open gastrectomy and robotic gastrectomy for elderly gastric cancer patients in China[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(03): 156-162.

目的

比较机器人及开腹胃癌根治术在高龄胃癌患者中的近期疗效,探究影响高龄胃癌术后并发症的独立危险因素。

方法

通过回顾性分析,收集2017年5月至2021年5月期间,于解放军总医院第一医学中心普通外科医学部,161例行开腹或机器人胃癌根治术、年龄≥70岁高龄患者的临床病例资料。两组基线资料及肿瘤病理学特征的比较,差异无统计学意义(P>0.05),具有可比性。比较两组围手术期指标,以评估近期疗效。二元Logistic回归探究影响术后并发症的独立危险因素。

结果

机器人组相比开腹组,手术时间显著延长[(242.92±55.12)min比(170.37±43.15)min, P<0.001]。尽管机器人组与开腹组术中估计出血量相当[100 ml (100~200) ml比100 ml (100~200)ml, P=0.102],但机器人组术中出血量(≥400 ml)的比例较开腹组显著降低(4.8%比15.4%),差异有统计学意义(P=0.025)。机器人组与开腹组在淋巴结清扫数目[(24.51±9.51)枚比(24.28±9.36)枚,P=0.881)]、术后住院时间[10.0 d (9.0~12.0)d比9.1 d(8.6~11.0)d,P=0.094]、术后总体并发症发生率(25.3%比26.9%, P=0.815)、严重并发症发生率(8.4%比3.8%, P=0.228)、吻合口漏发生率(2.4%比5.1%, P=0.363)、围手术期病死率(2.4%比1.3%, P=0.597)的差异无统计学意义。单因素及多因素分析结果显示,年龄≥80岁是影响高龄胃癌患者术后并发症发生的独立危险因素。

结论

在高龄胃癌患者中,行机器人胃癌根治术的近期疗效与开腹手术相当,操作安全、可行。年龄≥80岁是高龄胃癌术后并发症发生的独立危险因素,对此类患者应注重围手术期评估及术后护理,降低并发症发生率。

Objective

To analyze the short-term outcomes between open and robotic gastrectomy for elderly gastric cancer patients and explore the independent factors which influenced postoperative complications after gastrectomy.

Methods

A retrospective study was conducted. We collected clinical data of 161 elder patients (Age over 70 years) undergoing open or robotic gastrectomy in the department of general surgery, Chinese PLA General Hospital First Medical Center between May 2017 and May 2021 were collected. The characteristics of clinicopathological datas between two groups were not significantly different(P>0.05).

Results

The operative time was significantly longer in the robotic group compared to the open group [(242.92±55.12) min vs. (170.37±43.15)min, P<0.001]. Although intraoperative bleeding was comparable between the robotic and open groups [100 ml (100-200) ml vs. 100 ml (10-200) ml, P=0.102], the proportion of bleeding ≥400 ml was significantly lower in the robotic group compared with the open group(4.8% vs. 15.4%), with a statistically significant difference (P=0.025). The difference between the robotic and open groups were not statistically significant in the aspect of the number of retrieved lymph nodes [(24.51±9.51) vs. (24.28±9.36), P=0.881], postoperative hospital stay [10.0 d (9.0-12.0) d vs. 9.1 d (8.6-11.0) d, P=0.094], 30 days postoperative complication rate (25.3% vs. 26.9%, P=0.815), severe complication rate (8.4% vs. 3.8%, P=0.228), anastomotic leakage rate (2.4% vs. 5.1%, P=0.363), and 30 days postoperative mortality (2.4% vs. 1.3%, P=0.597). Univariate and multifactorial analyses showed that age ≥80 years was an independent risk factor for postoperative complications in elderly patients with gastric cancer.

Conclusions

Elderly patients who accepted robotic gastrectomy are safe and feasible. Over 80 years old is the independent risk factor of the postoperative complications after gastrectomy which needs to evaluate the surgical risk sufficiently.

表1 两组高龄胃癌患者临床病理特征比较
临床特征 开腹组(78例) 机器人组(83例) 统计值 P
性别[例(%)]     1.446 0.229
  61(78.2) 58(69.9)    
  17(21.8) 25(30.1)    
年龄(岁,±s) 74.77±4.28 75.25±4.49 -0.699 0.485
体质量指数(kg/m2±s) 23.54±3.19 23.60±3.11 -0.165 0.869
PNI评分(分,±s) 45.95±7.24 45.67±5.29 0.280 0.780
PNI评分比例[例(%)]     -0.437 0.662
  <40分 14(17.9) 10(12.0)    
  40~45分 26(33.3) 27(32.5)    
  46~50分 19(24.4) 31(37.3)    
  >50分 19(24.4) 15(18.1)    
既往腹部手术史[例(%)]     0.597 0.440
  55(70.5) 63(75.9)    
  23(29.5) 20(24.1)    
ASA分级[例(%)]     -1.024 0.306
  Ⅰ级 0(0.0) 2(2.4)    
  Ⅱ级 58(74.4) 64(77.1)    
  Ⅲ级 20(25.6) 17(20.5)    
CCI评分[例(%)]     0.379 0.538
  0~1分 66(84.6) 73(88.0)    
  2~4分 12(15.4) 10(12.0)    
手术切除范围[例(%)]     2.779 0.249
  近端 18(23.1) 28(33.7)    
  远端 41(52.6) 41(49.4)    
  全胃 19(24.4) 14(16.9)    
肿瘤直径[cm,M(IQR)] 4.0(2.9~6.0) 4.0(3.0~6.5) -0.636 0.525
肿瘤病理分期[例(%)]        
  pT     -0.204 0.838
    T1 19(24.4) 16(19.3)    
    T2 9(11.5) 11(13.2)    
    T3 38(48.7) 46(55.4)    
    T4 12(15.4) 10(12.0)    
  pN     1.656 0.198
    N0 35(44.9) 29(34.9)    
    N+ 43(55.1) 54(65.1)    
  pTNM     -0.641 0.521
    22(28.2) 21(25.3)    
    28(35.9) 28(33.7)    
    28(35.9) 34(41.0)    
肿瘤分化程度及类型[例(%)]     0.619 0.432
  高/中 48(61.5) 56(67.5)    
  低/未分化 30(38.5) 27(32.5)    
神经侵犯[例(%)]     0.710 0.399
  23(29.5) 30(36.1)    
  55(70.5) 53(63.9)    
脉管侵犯[例(%)]     0.715 0.399
  26(33.3) 33(39.8)    
  52(66.7) 50(60.2)    
表2 两组高龄胃癌患者围手术期指标比较
表3 高龄胃癌患者行外科手术治疗近期并发症发生影响因素分析
因素 单因素分析 多因素分析
OR (95%CI) P OR (95%CI) P
性别   0.696    
  1.000      
  0.850(0.375~1.924)      
年龄(岁)   0.062   0.047
  <80 1.000   1.000  
  ≥80 2.284(0.961~5.432)   2.534(1.011~6.348)  
体质量指数(kg/m2)   0.752    
  <25 1.000      
  ≥25 0.885(0.415~1.887)      
CCI评分(分)   0.892    
  0~1 1.000      
  2~4 1.073(0.390~2.952)      
PNI评分(分)   0.392    
  <40 1.000      
  40~50 0.534(0.208~1.369)      
  >50 0.513(0.163~1.611)      
手术时间(min)   0.847    
  ≤240 1.000      
  >240 0.925(0.417~2.051)      
手术方式   0.815    
  开腹手术 1.000      
  机器人手术 0.919(0.455~1.858)      
淋巴结转移情况   0.088   0.861
  1.000   1.000  
  1.940(0.906~4.154)   1.110(0.343~3.595)  
肿瘤切除范围   0.468    
  近端 1.000      
  远端 0.838(0.378~1.857)      
  全胃 0.508(0.172~1.503)      
病理分期   0.135   0.491
  1.000   1.000  
  1.714(0.624~4.710)   1.531(0.468~5.008)  
  2.634(1.003~6.917)   1.719(0.368~8.033)  
病理分型   0.123   0.534
  高/中 1.000   1.000  
  低/未分化 1.761(0.858~3.616)   1.288(0.580~2.861)  
肿瘤大小(cm)   0.760    
  ≤3 1.000      
  >3 1.128(0.520~2.446)      
神经侵犯   0.113   0.729
  1.000   1.000  
  1.800(0.870~3.725)   1.175(0.471~2.931)  
脉管侵犯   0.181   0.585
  1.000   1.000  
  1.632(0.797~3.341)   1.273(0.535~3.028)  
切缘有无肿瘤   0.313   0.497
  1.000   1.000  
  2.212(0.474~10.320)   1.744(0.350~8.690)  
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