Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang’s three-step maneuver for advanced upper gastric cancer: Results from a propensity scorematched study

作     者：Jia-Bin Wang Zhi-Yu Liu Qi-Yue Chen Qing Zhong Jian-Wei Xie Jian-Xian Lin Jun Lu Long-Long Cao Mi Lin Ru-Hong Tu Ze-Ning Huang Ju-Li Lin Hua-Long Zheng Si-Jin Que Chao-Hui Zheng Chang-Ming Huang Ping Li 

作者机构：Department of Gastric SurgeryFujian Medical University Union HospitalFuzhou 350001Fujian ProvinceChina Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhou 350001Fujian ProvinceChina 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2019年第25卷第37期

页      面：5641-5654页

核心收录：

学科分类：10[医学] 

基　　金：Supported by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province,China,No.2016Y9031 the Construction Project of Fujian Province Minimally Invasive Medical Center,No.171 the Second-batch Special Support Funds for Fujian Province Innovation and Entrepreneurship Talents,No.2016B013 Science and Technology Innovation Joint Fund Project of Fujian Province,No.2017Y9004 the Special Fund for Clinical Research of the Wu Jieping Medical Foundation,No.320.6750.17511 

主　　题：Advanced gastric cancer Robotic surgery Laparoscopic surgery Dissection of splenic hilar lymph node Propensity score matching Huang’s three-step maneuver 

摘      要：BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated *** To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step *** A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic *** In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent *** matching,there were no significant differences detected in the baseline characteristics between the two *** differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL.