机器人与腹腔镜手术治疗进展期Siewert Ⅱ/Ⅲ型食管胃结合部腺癌近期与远期疗效的比较OA

Objective:To investigate the differences in short-and long-term efficacy of robotic or laparoscopic gastrectomy in patients with advanced Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction(AEG).Methods:The clinical data of 387 patients with advanced Siewert type Ⅱ/Ⅲ AEG who underwent robotic or laparoscopic gastrectomy from Jan.2005 to Dec.2019 were retrospectively analyzed.Propensity score matching at a ratio of 1∶3 was adopted to eliminate potential confounding factors between the two groups.Patients were divided into the laparoscopic group and the robotic group according to the surgical method,with 89 cases in the robotic group and 267 cases in the laparoscopic group after matching.The matching variables included gender,age,BMI,history of abdominal surgery,ASA classification,Siewert type,degree of tumor differentiation,tumor size,extent of resection,postoperative chemo-therapy,and pathological stage.All patients in both groups underwent gastrectomy plus D2 lymph node dissection via the transhiatal approach.The primary study endpoints were the5-year overall survival rate(OS)and disease-free survival rate(DFS),and the sec-ondary study endpoints were the short-term postoperative outcome indicators.Results:Before propensity score matching,there was a sta-tistically significant difference in the total gastrectomy rate between the robotic group and the laparoscopic group(87.6%vs.76.5%,P=0.024).After propensity score matching,the baseline data of the two groups were comparable.Compared with the laparoscopic group,the robotic group had less intraoperative blood loss[100.0(100.0,150.0)mL vs.115.0(100.0,200.0)mL,P=0.007]and a higher number of dissected lymph nodes[(33.1±11.9)vs.(29.1±13.6),P=0.015].There were no statistically significant differ-ences in the R0 resection rate(98.9%vs.98.5%,P>0.999)and the length of proximal surgical margin[(2.5±0.9)cm vs.(2.5±1.0)cm,P=0.949]between the two groups.Unplanned reoperation occurred in 1 case(1.1%)in the robotic group and 4 cases(1.5%)in the laparoscopic group,with no statistically significant difference(P>0.999).In terms of long-term survival,the 5-year OS rate(41.6%vs.36.0%,P=0.452)and 5-year DFS rate(38.2%vs.34.8%,P=0.678)were similar between the two groups.COX regression model analysis indicated that undifferentiated tumor type(HR=1.440,95%CI=1.079～1.922,P=0.013;HR=1.364,95%CI=1.026～1.812,P=0.033)and pathological stage Ⅲ(HR=3.101,95%CI=1.504～6.392,P=0.002;HR=3.300,95%CI=1.600～6.804,P=0.001)were independent risk factors for 5-year OS and DFS in patients with advanced Siewert typeⅡ/Ⅲ AEG.In contrast,postoperative chemotherapy(HR=0.671,95%CI=0.497～0.905,P=0.009;HR=0.698,95%CI=0.519～0.938,P=0.017)was an independent protective factor for 5-year OS and DFS in patients with advanced SiewertⅡ/ⅢAEG.Conclusions:Robotic gastrectomy can achieve comparable short-and long-term efficacy to laparoscopic surgery in the treatment of advanced Siewert type Ⅱ/Ⅲ AEG.