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Safety of robotic double-flap technique following proximal gastrectomy in the introductory phase compared with laparoscopic procedure: a propensity score-matched analysis.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Oct2024, Vol. 38 Issue 10, p5824-5831. 8p. - Publication Year :
- 2024
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Abstract
- Background: Proximal gastrectomy (PG) is recommended for upper-third gastric cancer and esophagogastric junction (EGJ) cancer, preserving organ function while reducing postoperative symptoms. The double-flap technique (DFT) is one approach to minimize reflux after PG. However, laparoscopic PG with DFT (LPG-DFT) has drawbacks of increased complexity, such as hand sutures for anastomosis. Robotic surgery offers potential advantages for DFT reconstruction, but the safety of robotic DFT following PG (RPG-DFT) in the introductory phase is unknown. Methods: This retrospective study compared the outcomes of RPG-DFT with LPG-DFT. Data from 402 patients (321 LPG-DFT, 81 RPG-DFT) between 2009 and 2023 were analyzed. Propensity score matching balanced patient demographics and tumor characteristics. Surgical parameters, complications, and long-term outcomes were assessed. Results: The surgery time of LPG-DFT has stabilized in patients since 2016. Thus, LPG-DFT from 2016 was defined as a stable procedure. RPG-DFT was started in 2019, after minimally invasive DFT reconstruction had been mastered at our center. Therefore, we compared the surgical outcomes of introductory RPG-DFT with stable LPG-DFT. Matched analysis revealed that RPG-DFT in the introductory phase had significantly longer surgery times but less bleeding and shorter reconstruction times and hospital stays than stable LPG-DFT. Frequencies of short-term complications and reflux esophagitis were comparable in both groups. Although RPG-DFT in the introductory phase exhibited higher incidence of anastomotic stenosis than stable LPG-DFT, the incidence of anastomotic stenosis decreased over time. Conclusions: This study demonstrated the safety of RPG-DFT in the introductory phase for EGJ and upper-third stomach tumors, with outcomes comparable to stable LPG-DFT. RPG-DFT offers shorter reconstruction time and less blood loss compared with LPG-DFT. However, anastomotic stenosis is a complication to monitor in early robotic surgery. [ABSTRACT FROM AUTHOR]
- Subjects :
- *SURGICAL robots
*GASTRECTOMY
*PUBLIC hospitals
*PATIENT safety
*STOMACH tumors
*LAPAROSCOPIC surgery
*PROBABILITY theory
*FISHER exact test
*LOGISTIC regression analysis
*RETROSPECTIVE studies
*DESCRIPTIVE statistics
*CHI-squared test
*MANN Whitney U Test
*TREATMENT effectiveness
*SURGICAL complications
*MEDICAL records
*ACQUISITION of data
*COMPARATIVE studies
*DATA analysis software
*TIME
*HEMORRHAGE
*ESOPHAGUS diseases
*GASTROESOPHAGEAL reflux
*ESOPHAGEAL stenosis
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 38
- Issue :
- 10
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 180131584
- Full Text :
- https://doi.org/10.1007/s00464-024-11156-4