Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis
| Autor: | Sean Ryan, Amy E. Murphy, Ashley Tameron, David Y.W. Lee, Lala R. Hussain, Erik M. Dunki-Jacobs |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Adenocarcinoma Gastroenterology Cohort Studies 03 medical and health sciences Gastric adenocarcinoma 0302 clinical medicine Robotic Surgical Procedures Gastrectomy Stomach Neoplasms Internal medicine medicine Humans Propensity Score Aged business.industry Hazard ratio Laparoscopic gastrectomy Cancer Length of Stay Middle Aged medicine.disease Confidence interval 030220 oncology & carcinogenesis Propensity score matching Cohort Female Laparoscopy 030211 gastroenterology & hepatology Surgery business |
| Zdroj: | Surgical Innovation. 27:26-31 |
| ISSN: | 1553-3514 1553-3506 |
| DOI: | 10.1177/1553350619868113 |
| Popis: | Background. We compared the outcomes of laparoscopic-assisted (LA) and robotic-assisted (RA) gastrectomies performed for gastric adenocarcinoma in the National Cancer Database. Methods. The National Cancer Database was queried for patients 18 years old with stages I to III gastric adenocarcinoma who underwent LA or RA gastrectomy. Propensity matching was performed between the 2 groups with regard to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results. A cohort of 1893 (1262 = LA, 631 = RA) patients was identified in a 2:1 propensity matching. The groups were well matched. The rate of negative margin as well as 30- and 90-day mortality were similar between the 2 cohorts. Long-term survival was similar between the 2 groups (median survival 49.2 months in LA vs 56.2 months for RA, P = .405). However, the average number of lymph nodes (LNs) sampled was significantly higher in the RA group compared with the LA group (19.6 vs 17.4, P < .001). Similarly, the percentage of surgeries in which ≥15 LNs were sampled was also greater in the RA group compared with the LA group (63.9% vs 57.6%, P = .010). On multivariable analysis, having 15 LNs or more examined was associated with better survival (hazard ratio = 0.72, 95% confidence interval = 0.60-0.87, P < .001). Advanced age, nodal positivity, and advanced clinical stages were significantly associated with worse survival. Conclusions. RA gastrectomy may allow a greater harvest of LNs, and thus more accurate staging, without increasing short-term adverse outcomes compared with LA gastrectomy. Short-term and long-term outcomes in this well-matched cohort appear comparable for both approaches. |
| Databáze: | OpenAIRE |
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