Clinical efficacy of totally Da Vinci robotic surgical system in radical gastrectomy of gastric cancer

Abstract

Objective To investigate the safety and feasibility of totally Da Vinci robotic surgical system in the radical gastrectomy of gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinical data of 30 patients who underwent radical gastrectomy of gastric cancer via totally Da Vinci robotic surgical system in the Southwest Hospital of Army Medical University between June 2016 and August 2017 were collected. Surgical methods were selected according to Expert consensus on enhanced recovery after gastrectomy for gastric cancer (2016 edition). Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the patients′ postoperative survival and tumor recurrence and metastases up to September 2017. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were represented as median (range). Results (1) Surgical and postoperative situations: 30 patients underwent radical gastrectomy of gastric cancer using totally Da Vinci robotic surgical system, without conversion to laparoscopic or open surgery. Of 30 patients, 21 underwent distal subtotal gastrectomy including 1 with Billroth Ⅰ anastomosis and 20 with Billroth Ⅱ anastomosis, 9 underwent total gastrectomy with Roux-en-Y anastomosis. Of 30 patients, 1 underwent D1 radical gastrectomy, 24 underwent D2 radical gastrectomy and 5 underwent D2+ radical gastrectomy. The number of lymph node detected, length of abdominal incision, operation time and time of digestive tract reconstruction were 34±12, (4.1±0.5)cm, (269±52)minutes and (49±9)minutes in 30 patients, including 31±21, (4.0±0.9)cm, (253±61)minutes, 35 minutes (1 with Billroth Ⅰ anastomosis) and (38±10)minutes (20 with Billroth Ⅱ anastomosis) in 21 patients undergoing distal subtotal gastrectomy and 46±12, (4.0±0.5)cm, (325±30)minutes, (64±12)minutes in 9 patients undergoing total gastrectomy. The volume of intraoperative blood loss, postoperative pain score, time for out-of-bed activity, time of gastrointestinal function recovery, time for fluid food intake and time of drainage tube removal were (78±43)mL, 2.5±0.5, (33±8)hours, (59±13)hours, (66±32)hours and (64±21)hours, respectively. Of 30 patients, 2 with postoperative complications were cured by conservative treatment, including 1 of left lower lobe infection and 1 of abdominal abscess. Duration of postoperative hospital stay was (7±5)days. (2) Follow-up: 30 patients were followed up for 1.0-15.0 months, with a median time of 7.5 momths. During follow-up, 2 patients died of tumor recurrence at postoperative half year and 1 year, 1 patient still survived with tumor recurrence and other 27 patients had tumor-free survival. Conclusion The totally Da Vinci robotic surgical system is safe and feasible in the radical gastrectomy of gastric cancer, with good short-term outcomes. Key words: Gastric neoplasms; Gastrectomy; Da Vinci robotic surgical system, total