The safety assessment of robotic versus laparoscopic gastrectomy for gastric cancer using a propensity score matching method.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 55-55
Author(s):  
Rie Makuuchi ◽  
Tetsuro Toriumi ◽  
Yuhei Waki ◽  
Kenichi Nakamura ◽  
Satoshi Kamiya ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Laparoscopic Gastrectomy ◽  
Clinical Stage ◽  
Operation Time ◽  
Amylase Level ◽  
Randomized Controlled ◽  
Phase Ii Studies ◽  
Significant Difference

55 Background: We have previously reported the safety of robotic gastrectomy (RG) for clinical Stage IA or IB gastric cancer in single arm phase II studies. To date, a number of retrospective case control studies comparing RG and laparoscopic gastrectomy (LG) have been performed. However, since randomized controlled trials have never been conducted, no definitive conclusion demonstrating benefits of RG over LG has been demonstrated. In this study, we aimed to evaluate the safety of RG compared to LG using propensity score matching (PSM) methods. Methods: We retrospectively reviewed 766 consecutive patients who underwent either RG (n = 231) or LG (n = 535) for gastric cancer between January 2012 and December 2017. A 1:1 PSM was performed with the matched variables of age, sex, body mass index, performance status, clinical Stage, type of gastrectomy, and extent of lymphadenectomy. We compared short-term outcomes between the patients who underwent RG (RG group) and LG (LG group). Results: After PSM analysis, 231 patients were included in the RG group and 230 in the LG group. Intraoperative blood loss was similar between the groups. Operation time was significantly longer in the RG group (326 min vs. 281 min, P < 0.001). Significantly more lymph nodes were retrieved in the RG group (42 vs. 38.5, P = 0.031). Serum CRP level were significantly lower in the RG group in postoperative day 3 (9.0 mg/dL vs. 9.8 mg/dL, P = 0.049) and 6 (3.1 mg/dL vs. 3.7 mg/dL, P = 0.034), and drain amylase level in postoperative day 3 was also significantly lower in the RG group (612 U/L vs. 856 U/L, P < 0.001). Overall postoperative complication (Clavien–Dindo classification grade IIIA or greater) was similar between the groups (RG: 3.9% vs. LG: 5.6%, P = 0.656). However, pancreatic fistula tended to be less frequent in the RG group than in the LG group (0.4% vs. 2.2%, P = 0.122), although it did not reach statistically significant difference. Conclusions: Although RG takes longer operation time, it appears to be less invasive than LG with the possibility of decreased postoperative complications. To validate the results, randomized controlled trial should be performed.

scholarly journals Impact of Low Skeletal Muscle Mass on Complications and Survival for Gastric Cancer: A Propensity Score Matching Analysis

2021 ◽  
Author(s):  
Zhen Fang ◽  
Peijuan Li ◽  
Jin Liu ◽  
Wei Chong ◽  
Fengying Du ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Skeletal Muscle ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Muscle Mass ◽  
Laparoscopic Gastrectomy ◽  
Skeletal Muscle Mass ◽  
Significant Difference ◽  
The Impact

Abstract Background: Increasing evidence has indicated that low skeletal muscle mass is linked with cancer prognosis, but existing have shown contrasting results. The purpose of the study is to determine the impact of preoperative low skeletal muscle mass (LSMM) on complications and survival of patients who undergo laparoscopic gastrectomy for gastric cancer (GC).Methods: Patients who undergo laparoscopic gastrectomy for GC were enrolled and third lumbar vertebra psoas muscles index (PMI) was assessed by computer tomography (CT). Using propensity score matching (1:1) to obtain 2 well-balanced cohorts for available variables influencing clinical outcomes, comparing the postoperative complications and 3-year overall survival (OS) between LSMM group and non-LSMM group.Results: A total of 386 patients, 226 were matched for analyses. Compared with the non-LSMM group, the LSMM group manifested significantly shorter 3-year OS (58.14% vs 71.95%, P=0.034). However, the incidence of postoperative complications was no difference between two groups after matching. After stratification based on the pT stage of the tumor, statistically significant difference in the 3-year OS rates of the advance GC cohort between the two groups were observed.Conclusions: LSMM predicts a poor prognosis for patients with advance GC and it is not associated with postoperative complications.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2019 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Resection Margin ◽  
Operation Time ◽  
Clinicopathological Characteristics ◽  
Short Term ◽  
Significant Difference

Abstract Background Few studies have been designed to evaluate the short-term outcomes for advanced gastric cancer (AGC) between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) alone. The purpose of this study was to assess short-term outcomes of RATG compared with LATG for AGC.Methods We retrospectively evaluated 116 and 244 patients who underwent RATG or LATG respectively. Besides, we performed a propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes.Results After PSM, the RTAG group had longer mean operation time (291.09±58.41 vs. 271.99±48.41min, p=0.007), less intraoperative bleeding (151.98±92.83 vs. 172.59±97.01ml, p=0.032) and more N2 tier RLNs (9.33±5.46 vs. 7.50±3.86, p=0.018) than the LATG group. Besides, the total RLNs of RATG was at the brink of significance compared to LATG (35.09±12.93 vs.32.34±12.05, p=0.062). However, no significant differences were found between the two groups in terms of length of incision, proximal resection margin, distal resection margin, postoperative hospital stay. The conversion rate was 4.92% and 8.61% in the RATG and LATG groups, respectively, with no significant difference. The ratio of splenectomy was 1.7% and 0.4% respectively. There was no significant difference in overall complication rate between RATG and LATG groups before PSM (24.1% vs. 28.7%; p=0.341) and after PSM (24.1% vs. 33.6%; p=0.102). The grade II complications accounted for most of all complications in the two cohorts both before and after PSM.Conclusion This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Resection Margin ◽  
Operation Time ◽  
Short Term ◽  
Significant Difference

Abstract Background: Few studies have been designed to evaluate the short-term outcomes for advanced gastric cancer (AGC) between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) alone. The purpose of this study was to assess short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 116 and 244 patients who underwent RATG or LATG respectively. Besides, we performed a propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had longer operation time (291.09±58.41 vs. 271.99±48.41min, p=0.007), less intraoperative bleeding (151.98±92.83 vs. 172.59±97.01ml, p=0.032) and more N2 tier retrieved lymph nodes (RLNs) (9.33±5.46 vs. 7.50±3.86, p=0.018) than the LATG group. Besides, the total RLNs of RATG was more but not statistically significant compared to LATG (35.09±12.93 vs.32.34±12.05, p=0.062). However, no significant differences were found between the two groups in terms of length of incision, proximal resection margin, distal resection margin, postoperative hospital stay. The conversion rate was 4.92% and 8.61% in the RATG and LATG groups, respectively, with no significant difference (p=0.198). The ratio of splenectomy was 1.7% and 0.4% respectively (p=0.503). There was no significant difference in overall complication rate between RATG and LATG groups after PSM (24.1% vs. 33.6%; p=0.102)and the grade II complications accounted for most of all complications in the two cohorts. The mortality was 0.9% and 0% respectively (p=0.322). Conclusion : This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

scholarly journals Prognostic significance of splenectomy during completion total gastrectomy in patients with remnant gastric cancer: propensity score matching analysis

2021 ◽  
Vol 17 (2) ◽  
pp. 96-103
Author(s):  
Seung Hyun Back ◽  
Sung Eun Oh ◽  
Ji Yeong An ◽  
Min-Gew Choi ◽  
Tae Sung Sohn ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Significant Prognostic Factor ◽  
Remnant Gastric Cancer ◽  
Significant Difference ◽  
The Impact

Purpose: Splenectomy for patients with remnant gastric cancer has been controversial. The purpose of this study is to identify the impact of splenectomy in the treatment of remnant gastric cancer.Methods: We retrospectively analyzed 285 patients with remnant gastric cancer who underwent completion total gastrectomy with or without splenectomy in Samsung Medical Center, between September 1996 and December 2017. We used a 1:1 propensity score matching method for the analysis. The matching factors were age, sex, and pathologic stage. After the matching process, we compared the 5-year overall survival (OS) and the disease-free survival (DFS) between patients with and without splenectomy during completion total gastrectomy.Results: The median duration of follow-up was 58.0 months (range, 0–132 months). After propensity score matching, there were no statistically significant differences between the splenectomy group (n = 77) and no splenectomy group (n = 77) in terms of clinicopathological features. The 5-year OS rate between the no splenectomy and splenectomy group were not significantly different. There was no significant difference between 5-year DFS of the matched groups. Multivariate analysis revealed that splenectomy is not a significant prognostic factor in terms of 5-year OS (no splenectomy vs. splenectomy; 61.5% vs. 60.2%, P = 0.884) or DFS (74.9% vs. 69.8%, P = 0.880).Conclusion: Splenectomy has no impact on the OS and DFS in patients with remnant gastric cancer. Splenectomy during completion total gastrectomy may not be necessary.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Resection Margin ◽  
Short Term ◽  
Conversion Rates ◽  
Significant Difference

Abstract Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14±59.18 vs. 270.34±52.22 min, p=0.003), less intraoperative bleeding (154.37±89.68 vs. 183.77±95.39 ml, p=0.004) and more N2 tier RLNs (9.07±5.34 vs. 7.56±4.50, p=0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90±13.05 vs. 31.91±12.46, p=0.065).Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p=0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55% and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p=0.145), and the ratio of splenectomy were 1.59% and 0.39% (p=0.253). The mortality rates were 0.8% and 0.4% for the RATG and LATG groups, respectively (p=1.000). Conclusion : This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis

2021 ◽  
Author(s):  
Qiang Zhang ◽  
Zhou-yang Lian ◽  
Jian-Qun Cai ◽  
Yang Bai ◽  
Zhen Wang
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Operation Time ◽  
Intraepithelial Neoplasia ◽  
R0 Resection ◽  
En Bloc ◽  
Propensity Score Matching Analysis ◽  
Significant Difference ◽  
Traction Group

Summary Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20–100 min); nontraction group, 70.0 min (range, 35–133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Resection Margin ◽  
Short Term ◽  
Conversion Rates ◽  
Significant Difference

Abstract Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14±59.18 vs. 270.34±52.22 min, p=0.003), less intraoperative bleeding (154.37±89.68 vs. 183.77±95.39 ml, p=0.004) and more N2 tier RLNs (9.07±5.34 vs. 7.56±4.50, p=0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90±13.05 vs. 31.91±12.46, p=0.065).Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p=0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55% and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p=0.145), and the ratio of splenectomy were 1.59% and 0.39% (p=0.253). The mortality rates were 0.8% and 0.4% for the RATG and LATG groups, respectively (p=1.000).Conclusion: This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Resection Margin ◽  
Short Term ◽  
Conversion Rates ◽  
Significant Difference

Abstract Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14±59.18 vs. 270.34±52.22 min, p=0.003), less intraoperative bleeding (154.37±89.68 vs. 183.77±95.39 ml, p=0.004) and more N2 tier RLNs (9.07±5.34 vs. 7.56±4.50, p=0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90±13.05 vs. 31.91±12.46, p=0.065).Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p=0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55% and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p=0.145), and the ratio of splenectomy were 1.59% and 0.39% (p=0.253). The mortality rates were 0.8% and 0.4% for the RATG and LATG groups, respectively (p=1.000). Conclusion : This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

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