Clinical effect of vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy for gastric cancer

Abstract

Objective To explore the safety and feasibility of vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy for gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 12 gastric cancer patients who underwent vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy at the Southwest Hospital of the Third Military Medical University from January 2015 to November 2016 were collected. All patients underwent vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy for gastric cancer. During operation, lymph node dissection of the pyloric region, the right side of the cardia and the superior margin of the pancreas were noticed, and other surgical procedures were the same as the traditional Da Vinci robot-assisted radical gastrectomy. Observation indicators: (1) intra- and post-operative situations: surgical methods, digestive tract reconstruction, operation time, volume of intraoperative blood loss, number of lymph node dissected, results of postoperative pathological examination, recovery time of gastrointestinal function, time for liquid diet intake, duration of postoperative hospital stay, short-term surgery-related complications (postoperative bleeding, anastomotic fistula, obstruction and intra-abdominal infection); (2) follow-up situations: postoperative long-term complications (gastric retention, alkaline reflux gastritis, dumping syndrome, gallbladder disease and cholelithiasis), postoperative quality of life (diet, upper abdominal discomfort, nausea, vomiting and diarrhea), postoperative nutritional status [body weight, hemoglobin (Hb), total protein (TP), albumin (Alb)] and tumor recurrence. Follow-up using telephone interview and outpatient examination was performed up to December 2016. Telephone interview included detecting diet of patients, digestive tract symptoms and body weight. Routine blood test, liver and kidney functions, tumor markers, chest X-ray, abdominal computed tomography (CT) or color Doppler ultrasound and gastroscopy of outpatient examinations were performed to detect tumor recurrence and metastasis. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range). Results (1) Intra- and post-operative situations: all the 12 patients underwent successful vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy for gastric cancer, without conversion to laparoscopic surgery or open surgery, including 2 patients with D1 lymphadenectomy, 2 patients with extended D1 lymphadenectomy and 8 patients with D2 lympha-denectomy. Five and 7 patients underwent respectively Billroth Ⅰ anastomosis and Billroth Ⅱ anastomosis of digestive tract reconstruction. Operation time, volume of intraoperative blood loss and number of lymph node dissected of 12 patients were (247±34)minutes, (94±23)mL and 27±7, respectively. Results of postoperative pathological examination showed that distal and proximal surgical margins of 12 patients were negative and achieved R0 resection; 326 lymph nodes were dissected, 6 patients didn′t have lymph node metastasis and 18 positive lymph nodes were detected in 6 patients. Recovery time of gastrointestinal function, time for liquid diet intake and duration of postoperative hospital stay in 12 patients were (57±14)hours, (64±14)hours and (7.3±0.9)days, respectively. There was no occurrence of short-term surgery-related complications. (2) Follow-up situations: 12 patients were followed up by telephone interview (10 receiving outpatient examinations) for 9 months (range, 1-20 months). Of 12 patients with long-term complications, 2 had loss of appetite, 1 had diarrhea, without occurrence of cholelithiasis, cholecystitis, gastric retention and dumping syndrome. Of 10 patients receiving outpatient examinations, body weight, Hb, TP and Alb were (56±12)kg, (126±10)g/L, (69.9±5.1)g/L, (43.2±3.3)g/L at 1 month postoperatively and (52±13)kg, (126±10)g/L, (72.1±2.4)g/L, (45.2±1.6)g/L at 3 months postoperatively, respectively, with negative carcinoembryonic antigen. There was no tumor recurrence and metastasis in 12 patients. Conclusion Vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy is safe and feasible for gastric cancer, which has not affected the lymph node dissection and incidence of surgery-related complications, and it also can improve the postoperative quality of life and maintain good nutritional status. Key words: Gastric neoplasms; Radical gastrectomy; Da Vinci robotic surgical system; Vagus nerve-preserving