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Robotic spleen-preserving splenic hilar lymphadenectomy for advanced proximal gastric cancer: A feasible and simplified procedure
Surgical Oncology 28 (2019) 67–68
Contents lists available at ScienceDirect
Surgical Oncology journal homepage: www.elsevier.com/locate/suronc
Robotic spleen-preserving splenic hilar lymphadenectomy for advanced proximal gastric cancer: A feasible and simplified procedure☆
T
Qi-Yue Chena,b,c,d,1, Qing Zhonga,b,c,d,1, Chao-Hui Zhenga,b,c,d,∗∗, Chang-Ming Huanga,b,c,d,∗ a
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China c Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China d Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China b
ARTICLE INFO
ABSTRACT
Keywords: Gastric cancer Robotic surgery Splenic hilar lymphadenectomy
Background: Robotic systems recently have been introduced to overcome technical limitations of conventional laparoscopic gastrectomy, especially for complex procedures [1]. We developed a set of procedural operation steps for robotic spleen-preserving splenic hilar lymphadenectomy, which is difficult and recommended in D2 lymph node (LN) dissection during total gastrectomy [2–4]. Methods: The robotic operative procedures of splenic hilar lymphadenectomy using the da Vinci® Si system were demonstrated in a step-by-step manner, with technical tips for each step, in the video clip. The above procedures were performed on 40 consecutive patients with stage cT2-3 proximal gastric cancer between July 2016 and September 2017. The learning curve was analyzed based on the cumulative sum method (CUSUM). Results: The mean age and body mass index of patients were 55.3 ± 10.4 years (range 29–78) and 23.0 ± 2.7 kg/m2 (range 15.4–28.4), respectively. All spleen-preserving surgeries were successfully performed without open or laparoscopy conversion. Mean operation time of splenic hilar lymphadenectomy was 20.3 ± 6.4 min (range 13.3–46.3); mean blood loss was 13.7 ± 5.3 ml (range 8.0–40.0). The overall average of 38.8 ± 13.1 LNs (range 19–81) was retrieved, including a mean 3.3 ± 1.4 (range 0–8) splenic hilar area LNs, with a 10% (4/ 40) metastatic rate. No immediate postoperative mortality was observed. 6 patients (15.0%) experienced a complication after surgery; the operation-related complications consisted of one wound complications, one abdominal infection, and one anastomosis leakage. At a median follow-up of 12 months, one patient had experienced lung metastasis. According to the CUSUM, the cut-off point of splenic hilar LN dissection time and blood loss were 15th and 20th cases, respectively. Conclusion: Robotic surgery can improve the quality of surgery and promote the D2 LN dissection. This procedure is feasible and simplifies complicated splenic hilar lymphadenectomy.
Disclosures
Human rights statement and informed consent
The authors, including ZQ, CQY, ZCH, and HCM made no disclosures.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.
☆ Supported by Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031). Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171). The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013). General project of Miaopu scientific research fund of Fujian Medical University (2015MP021). Youth Project of Fujian Provincial Health and Family Planning Commission (2016-1-41). 2017 Fujian science and technology innovation joint fund project (2017Y9004). ∗ Corresponding author. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. ∗∗ Corresponding author. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. E-mail addresses: [email protected] (C.-H. Zheng), [email protected] (C.-M. Huang). 1 Chen QY and Zhong Q contributed equally to this work and should be considered co-first authors.
https://doi.org/10.1016/j.suronc.2018.11.014 Received 29 July 2018; Received in revised form 26 September 2018; Accepted 10 November 2018 0960-7404
Surgical Oncology 28 (2019) 67–68
Q.-Y. Chen et al.
Acknowledgements
2014. [2] T. Sano, M. Sasako, J. Mizusawa, S. Yamamoto, H. Katai, T. Yoshikawa, A. Nashimoto, S. Ito, M. Kaji, H. Imamura, Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma, Ann. Surg. 265 (2) (2017) 277. [3] J.G.C. Association, Japanese gastric cancer treatment guidelines 2014 (ver. 4), Gastric Cancer Official Journal of the International Gastric Cancer Association & the Japanese Gastric Cancer Association 20 (1) (2017) 1–19. [4] C.M. Huang, T. Chen, J.X. Lin, Q.Y. Chen, C.H. Zheng, P. Li, J.W. Xie, J.B. Wang, J. Lu, L.L. Cao, The effects of laparoscopic spleen-preserving splenic hilar lymphadenectomy on the surgical outcome of proximal gastric cancer: a propensity scorematched, case-control study, Surg. Endosc. 31 (3) (2017) 1383.
We thank Lei Lin and Bin Lin for the help of narration. Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.suronc.2018.11.014. References [1] K. Obama, W.J. Hyung, Robotic Gastrectomy for Gastric Cancer, Springer Japan,
68
Contents lists available at ScienceDirect
Surgical Oncology journal homepage: www.elsevier.com/locate/suronc
Robotic spleen-preserving splenic hilar lymphadenectomy for advanced proximal gastric cancer: A feasible and simplified procedure☆
T
Qi-Yue Chena,b,c,d,1, Qing Zhonga,b,c,d,1, Chao-Hui Zhenga,b,c,d,∗∗, Chang-Ming Huanga,b,c,d,∗ a
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China c Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China d Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China b
ARTICLE INFO
ABSTRACT
Keywords: Gastric cancer Robotic surgery Splenic hilar lymphadenectomy
Background: Robotic systems recently have been introduced to overcome technical limitations of conventional laparoscopic gastrectomy, especially for complex procedures [1]. We developed a set of procedural operation steps for robotic spleen-preserving splenic hilar lymphadenectomy, which is difficult and recommended in D2 lymph node (LN) dissection during total gastrectomy [2–4]. Methods: The robotic operative procedures of splenic hilar lymphadenectomy using the da Vinci® Si system were demonstrated in a step-by-step manner, with technical tips for each step, in the video clip. The above procedures were performed on 40 consecutive patients with stage cT2-3 proximal gastric cancer between July 2016 and September 2017. The learning curve was analyzed based on the cumulative sum method (CUSUM). Results: The mean age and body mass index of patients were 55.3 ± 10.4 years (range 29–78) and 23.0 ± 2.7 kg/m2 (range 15.4–28.4), respectively. All spleen-preserving surgeries were successfully performed without open or laparoscopy conversion. Mean operation time of splenic hilar lymphadenectomy was 20.3 ± 6.4 min (range 13.3–46.3); mean blood loss was 13.7 ± 5.3 ml (range 8.0–40.0). The overall average of 38.8 ± 13.1 LNs (range 19–81) was retrieved, including a mean 3.3 ± 1.4 (range 0–8) splenic hilar area LNs, with a 10% (4/ 40) metastatic rate. No immediate postoperative mortality was observed. 6 patients (15.0%) experienced a complication after surgery; the operation-related complications consisted of one wound complications, one abdominal infection, and one anastomosis leakage. At a median follow-up of 12 months, one patient had experienced lung metastasis. According to the CUSUM, the cut-off point of splenic hilar LN dissection time and blood loss were 15th and 20th cases, respectively. Conclusion: Robotic surgery can improve the quality of surgery and promote the D2 LN dissection. This procedure is feasible and simplifies complicated splenic hilar lymphadenectomy.
Disclosures
Human rights statement and informed consent
The authors, including ZQ, CQY, ZCH, and HCM made no disclosures.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.
☆ Supported by Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031). Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171). The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013). General project of Miaopu scientific research fund of Fujian Medical University (2015MP021). Youth Project of Fujian Provincial Health and Family Planning Commission (2016-1-41). 2017 Fujian science and technology innovation joint fund project (2017Y9004). ∗ Corresponding author. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. ∗∗ Corresponding author. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. E-mail addresses: [email protected] (C.-H. Zheng), [email protected] (C.-M. Huang). 1 Chen QY and Zhong Q contributed equally to this work and should be considered co-first authors.
https://doi.org/10.1016/j.suronc.2018.11.014 Received 29 July 2018; Received in revised form 26 September 2018; Accepted 10 November 2018 0960-7404
Surgical Oncology 28 (2019) 67–68
Q.-Y. Chen et al.
Acknowledgements
2014. [2] T. Sano, M. Sasako, J. Mizusawa, S. Yamamoto, H. Katai, T. Yoshikawa, A. Nashimoto, S. Ito, M. Kaji, H. Imamura, Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma, Ann. Surg. 265 (2) (2017) 277. [3] J.G.C. Association, Japanese gastric cancer treatment guidelines 2014 (ver. 4), Gastric Cancer Official Journal of the International Gastric Cancer Association & the Japanese Gastric Cancer Association 20 (1) (2017) 1–19. [4] C.M. Huang, T. Chen, J.X. Lin, Q.Y. Chen, C.H. Zheng, P. Li, J.W. Xie, J.B. Wang, J. Lu, L.L. Cao, The effects of laparoscopic spleen-preserving splenic hilar lymphadenectomy on the surgical outcome of proximal gastric cancer: a propensity scorematched, case-control study, Surg. Endosc. 31 (3) (2017) 1383.
We thank Lei Lin and Bin Lin for the help of narration. Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.suronc.2018.11.014. References [1] K. Obama, W.J. Hyung, Robotic Gastrectomy for Gastric Cancer, Springer Japan,
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