Непосредственные результаты робот-ассистированных оперативных вмешательств при раке желудка

Abstract

Background: stomach cancer is the 5th most common cancer worldwide and the 3rd leading cause of cancer death. In recent years, minimally invasive (including robot-assisted) techniques have been actively implemented in surgery for urological, gynecological, and gastrointestinal cancers. Aim: to summarize the experience with robot-assisted surgical interventions for gastric cancer and to demonstrate direct surgical outcomes. Patients and Methods: in 2018–2022, 111 patients (60 men and 51 women) with gastric cancer underwent robot-assisted surgery. The mean age was 64.6±5.5 years (33–78). The mean body mass index (BMI) was 27.9±2.8 kg/m2, 39.2% of patients had obesity (BMI>30 kg/m2). The tumor was located in the gastric cardia in 19 patients (17.1%), upper third of the stomach in 9 patients (8.1%), middle third of the stomach in 4 patients (3.6%), lower third of the stomach in 21 patients (18, 9%), and gastric antrum in 58 patients (52.3%). Distal subtotal gastric resection was performed in middle-third and lower-third gastric carcinomas. Gastrectomy was performed in the upper-third and gastric cardiac carcinoma. Two surgical systems, Da Vinci® Si and Da Vinci® Xi, were used for surgical interventions. Results: 79 distal subtotal gastric resections and 32 gastrectomies were performed. The median duration of distal subtotal gastric resection and gastrectomy was 210.5 min [178.8; 249.5] and 285.0 min [275.5; 303.0], respectively. The median intraoperative blood loss was 65.0 ml [10.0; 170.0], and the median number of removed lymph nodes was 29.0 [18.0; 43.0]. Histological examination revealed clear resection margins (R0) in all patients. The conversion of surgical access was required in 2 patients (1.8%). Death was reported in 1 patient (0.9%). Clavien–Dindo grade III–IV postoperative complications were detected in 7 patients (6.3%). The median in-hospital stay was 7.0 days [7.0; 10.0] after distal subtotal gastric resection and 9.0 days [9.0; 12.0] after gastrectomy. Conclusion: our findings support the global experience with robot-assisted surgical interventions for gastric cancer with minimal intra- and postoperative complications, which generally occur in elderly patients with severe comorbidities, obesity, and locally advanced cancer at baseline. KEYWORDS: robotic surgery, gastric cancer, oncology, gastric resection, gastrectomy. FOR CITATION: Kovalenko S.A., Gladyshev D.V., Moiseev M.E., Vetoshkin V.A., Svitich V.Yu., Gnedash S.S. Immediate outcomes of robot- assisted surgical interventions for gastric cancer. Russian Medical Inquiry. 2023;7(6):353–358 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-6-3.