Lin Chen, Yunhe Gao, Jiyang Li, Jianxin Cui, Tianyu Xie, Hongqing Xi, Wenquan Liang, Kecheng Zhang, Bo Wei, Zhi Qiao. Chinese People’s Liberation Army General Hospital
INTRODUCTION: Minimal invasive surgery has now been rapidly applied in early and advanced gastric cancer (GC), even in overweight GC patients that are technically challenging. However, the role of robotic assisted gastrectomy (RAG) in overweight GC patients has rarely been investigated. This study aimed to compare safety, feasibility and the learning curve of robotic and laparoscopic gastrectomy with D2 lymphadenectomy in overweight Chinese GC patients.
METHODS AND PROCEDURES: Between July 2015 and November 2016, we retrospectively investigated 186 consecutive overweight GC patients (BMI≥24) underwent distal gastrectomy with D2 lymphadenectomy (81 for RAG and 105 for LAG) performed by two surgeons. The clinicopathological and surgical features were compared between groups. The cutoff point for initial phase (phase I) and stable phase (phase II) were determined by cumulative sum (CUSUM) curve of operation time.
RESULTS: Generally, the surgical outcomes including postoperative complication rate, duration of postoperative hospital stay and lymph nodes harvest in the overweight patients have comparable results between RAG and LAG groups. The cutoff determining phase I and II according to the CUSUM figure for RAG group was 15 and 10 cases for surgeon A and B, respectively. And comparison analysis showed that the operation time of phase II RAG was significantly shorter (Surgeon A: 311.3±63.2 vs 272.3±44.8min, p=0.035; Surgeon B: 238.3±64.8 vs 280.5±48.5min, p=0.027) than phase I. And more lymph nodes (Surgeon A: 29.4±9.1 vs 24.0±6.2, p=0.045; Surgeon B: 31.2±8.6 vs 25.8±6.3, p=0.023) were retrieved and less estimated blood loss (Surgeon A: 155.2±115.6 vs 231.6±174.5 ml, p=0.035; Surgeon B: 117.8±89.6 vs 181.5±116.2ml, p=0.018) were observed in phase II than phase I while other major clinical features remains insignificant.
CONCLUSIONS: Our study showed that robotic assisted gastrectomy is a safe and feasible surgical procedure for overweight Chinese GC patients with D2 lymphadenectomy, especially after the initial learning phase. The duration difference of initial phase between different surgeons might indicate a short learning process in robotic distal gastrectomy for an experienced surgeon.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87593
Program Number: P778
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster