Kết quả sớm của phẫu thuật robot cắt bán phần dưới dạ dày và nạo hạch D2 trong điều trị ung thư dạ dày

Tóm tắt

Đặt vấn đề: Ung thư dạ dày (UTDD) là một trong năm loại ung thư phổ biến nhất tại Việt Nam và trên thế giới. Phẫu thuật robot cắt dạ dày và nạo hạch trở thành xu hướng điều trị mới trong UTDD. Tại Việt Nam, chúng tôi tiến hành nghiên cứu sau để tìm hiểu tính an toàn và khả thi của phương pháp phẫu thuật này.

Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả hàng loạt ca: 13 trường hợp ung thư dạ dày 1/3 dưới được phẫu thuật bằng robot da Vinci thế hệ Si tại bệnh viện Bình Dân từ 01/01/2017 đến 31/7/2019.

Kết quả: Tỉ lệ nam : nữ là 2,25 : 1. Độ tuổi trung bình là 56,92 ± 8,66 tuổi. Giai đoạn bệnh trước mổ (cTNM) đa số là giai đoạn III. Thời gian docking robot là 15 ± 7,36 phút. Thời gian mổ toàn bộ là 225,38 ± 36,43 phút. Lượng máu mất trong mổ là 66,15 ± 23,64 ml. Tỉ lệ tai biến và biến chứng sớm là 0%. Thời gian nằm viện sau mổ là 7,62 ngày ± 0,87 ngày. Tổng số hạch di căn là 1,62 ± 1,61 hạch. Giai đoạn bệnh sau mổ bao gồm IIIA (53,85%), IIB (23,08%), IIA (15,38%), IB (7,69%).

Kết luận: Phẫu thuật bằng robot cắt dạ dày là một phương pháp phẫu thuật an toàn với các chỉ số trong mổ và sau mổ đầy khả quan.

Từ khóa: Phẫu thuật robot, ung thư dạ dày.

Tài liệu tham khảo

1. Bosman F.T., Carneiro F., Hruban R.H. và cộng sự. (2010). WHO Classification of Tumours of the Digestive System, Fourth Edition. International Agency for Research on Cancer. 4th, International Agency for Research on Cancer, Lyon, 417.
2. Camarillo D.B., Krummel T.M., và Salisbury J.K. (2004). Robotic technology in surgery: Past, present, and future. Am J Surg, 188(4), 2–15.
3. Choi Y.Y., Noh S.H., và Cheong J.H. (2015). Evolution of gastric cancer treatment: From the golden age of surgery to an era of precision medicine. Yonsei Medical Journal, 56, 1177–1185.
4. Ferlay J., Soerjomataram I., Dikshit R. và cộng sự. (2015). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 136(5), 359–386.
5. Gunderson L.L., Hamilton S.R., Jessup J.M. và cộng sự. (2017). American Joint Committee on Cancer Staging Manual. 8th Edition. Colon and Rectum. American Joint Committee on Cancer Staging Manual. 8th Edition. 8th, Springer, New York, NY, 251–274.
6. Huang K.H., Lan Y.T., Fang W.L. và cộng sự. (2012). Initial Experience of Robotic Gastrectomy and Comparison with Open and Laparoscopic Gastrectomy for Gastric Cancer. J Gastrointest Surg, 16(7), 1303-1310.
7. Hyung W.J., Kim S.S., Choi W.H. và cộng sự. (2008). Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution. Yonsei Medical Journal, 49, 409–415.
8. Junfeng Z., Yan S., Bo T. và cộng sự. (2013). Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc, 28(6), 1779–1787.
9. Kim H.I., Park M.S., Song K.J. và cộng sự. (2014). Rapid and safe learning of robotic gastrectomy for gastric cancer: Multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg Oncol, 40(10), 1346–1354.
10. Kim M.-C., Heo G.-U., và Jung G.-J. (2009). Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc, 24(3), 610–615.
11. Lee H.H., Hur H., Jung H. và cộng sự. (2011). Robot-assisted distal gastrectomy for gastric cancer: initial experience. Am J Surg, 201(6), 841–845.
12. Procopiuc L. (2016). Robot-assisted surgery for gastric cancer. World J Gastrointest Oncol, 8(1), 8.
13. Sano T. và Kodera Y. (2011). Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer, 14(2), 101–112.
14. Shen L., Shan Y.S., Hu H.M. và cộng sự. (2013). Management of gastric cancer in Asia: Resource-stratified guidelines. Lancet Oncol, 14(12), 535–547.
15. Song J., Oh S.J., Kang W.H. và cộng sự. (2009). Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg, 249, 927–932.
16. Toh J.W.T. và Kim S.H. (2018). Port positioning and docking for single-stage totally robotic dissection for rectal cancer surgery with the Si and Xi Da Vinci Surgical System. J Robot Surg, 12(3), 545–548.
17. Uyama I., Kanaya S., Ishida Y. và cộng sự. (2011). Novel Integrated Robotic Approach for Suprapancreatic D2 Nodal Dissection for Treating Gastric Cancer: Technique and Initial Experience. World J Surg, 36(2), 331–337.
18. Watanabe G. (2014), Robotic Surgery, Springer Japan, Tokyo.
19. Zhou J., Shi Y., Qian F. và cộng sự. (2015). Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol, 111(6), 760–767.
20. (2017). Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 20(1), 1–19.

Early outcomes of robotic distal gastrectomy with D2 lymphadenectomy for gastric cancer at Binh Dan Hospital

Tran Vinh Hung, Hoang Vinh Chuc, Nguyen Phuc Minh, Vu Khuong An

Binh Dan Hospital

Received date: 10 Nov 2020

Accepted date: 25 May 2021

Published date: 03 June 2021

Abstract

Introduction: Gastric cancer is one of the five most common malignancies in Vietnam and worldwide. Recently, robotic gastrectomy with lymphadenectomy has become a new trend in the treatment of gastric cancer. In Vietnam, we conducted this study to assess the safety and feasibility of this procedure.

Patients and methods: Descriptive study with a case series enrolled 13 patients with lower third gastric cancer underwent gastrectomy with lymphadenectomy by Si-generation da Vinci robot at Binh Dan Hospital from 01/01/2017 to 31/07/2019.

Results: Male/female ratio was 2.25:1. The median age was 56.92 ± 8.66 years old. The pre-operative staging (cTNM) was mostly stage III. Robot docking time was 15 ± 7.36 minutes. The total operating time was 225.38 ± 36.43 minutes. The average blood loss during surgery was 66.15 ± 23.64 ml. There were no intraoperative accident as well as early postoperative complication. The postoperative hospital stay was 7.62 ± 0.87 days. The total number of metastatic lymph nodes was 1.62 ± 1.61 nodes. The postoperative staging was IIIA (53.85%), IIB (23.08%), IIA (15.38%) and IB (7.69%) respectively.

Conclusions: Robotic gastrectomy is a safe procedure with promising indexes during and after surgery.

Key word: Gastric cancer, robotic surgery.

References

1. Bosman F.T., Carneiro F., Hruban R.H. et al. (2010). WHO Classification of Tumours of the Digestive System, Fourth Edition. International Agency for Research on Cancer. 4th, International Agency for Research on Cancer, Lyon, 417.
2. Camarillo D.B., Krummel T.M., and Salisbury J.K. (2004). Robotic technology in surgery: Past, present, and future. Am J Surg, 188(4), 2–15.
3. Choi Y.Y., Noh S.H., and Cheong J.H. (2015). Evolution of gastric cancer treatment: From the golden age of surgery to an era of precision medicine. Yonsei Medical Journal, 56, 1177–1185.
4. Ferlay J., Soerjomataram I., Dikshit R. et al. (2015). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 136(5), 359–386.
5. Gunderson L.L., Hamilton S.R., Jessup J.M. et al. (2017). American Joint Committee on Cancer Staging Manual. 8th Edition. Colon and Rectum. American Joint Committee on Cancer Staging Manual. 8th Edition. 8th, Springer, New York, NY, 251–274.
6. Huang K.H., Lan Y.T., Fang W.L. at al. (2012). Initial Experience of Robotic Gastrectomy and Comparison with Open and Laparoscopic Gastrectomy for Gastric Cancer. J Gastrointest Surg, 16(7), 1303–1310.
7. Hyung W.J., Kim S.S., Choi W.H. et al. (2008). Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution. Yonsei Medical Journal, 49, 409–415.
8. Junfeng Z., Yan S., Bo T. et al. (2013). Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc, 28(6), 1779–1787.
9. Kim H.I., Park M.S., Song K.J. et al. (2014). Rapid and safe learning of robotic gastrectomy for gastric cancer: Multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg Oncol, 40(10), 1346–1354.
10. Kim M.-C., Heo G.-U., and Jung G.-J. (2009). Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc, 24(3), 610–615.
11. Lee H.H., Hur H., Jung H. et al. (2011). Robot-assisted distal gastrectomy for gastric cancer: initial experience. Am J Surg, 201(6), 841–845.
12. Procopiuc L. (2016). Robot-assisted surgery for gastric cancer. World J Gastrointest Oncol, 8(1), 8.
13. Sano T. v Kodera Y. (2011). Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer, 14(2), 101–112.
14. Shen L., Shan Y.S., Hu H.M. et al. (2013). Management of gastric cancer in Asia: Resource-stratified guidelines. Lancet Oncol, 14(12), 535–547.
15. Song J., Oh S.J., Kang W.H. et al. (2009). Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg, 249, 927–932.
16. Toh J.W.T. and Kim S.H. (2018). Port positioning and docking for single-stage totally robotic dissection for rectal cancer surgery with the Si and Xi Da Vinci Surgical System. J Robot Surg, 12(3), 545–548.
17. Uyama I., Kanaya S., Ishida Y .et al. (2011). Novel Integrated Robotic Approach for Suprapancreatic D2 Nodal Dissection for Treating Gastric Cancer: Technique and Initial Experience. World J Surg, 36(2), 331–337.
18. Watanabe G. (2014), Robotic Surgery, Springer Japan, Tokyo.
19. Zhou J., Shi Y., Qian F. et al. (2015). Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol, 111(6), 760–767.
20. (2017). Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 20(1), 1–19.