Clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer

Objective To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected. There were 37 males and 10 females, aged from 23 to 75 years, with an average age of 60 years. Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were expressed by M (range). Count data were represented as absolute numbers. Results (1) Intraoperative situations: 47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer, without conversion to open surgery. The operation time, hilar lymph node dissection time, volume of intraoperative blood loss, number of lymph node dissected, number of splenic hilar lymph node dissected, number of metastatic lymph nodes, number of metastatic splenic hilar lymph node were (225±36) minutes, (20±6) minutes, (40±27) mL, 40 (range, 17-112), 2 (range, 0-10), 2 (range, 0-29), 0 (range, 0-3). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to gastric tube removal, time to initial liquid diet intake, time to initial semi-liquid diet intake, time to drainage tube removal, and duration of postoperative hospital stay were (2.0±0.3)days, (3.4±0.9)days, (3.4±1.1)days, (4.8±1.0)days, (6.7±1.5)days, (8.5±2.5)days, and (12.0±8.3)days, respectively. Of 47 patients, 3, 2, 1, 1, and 1 were detected pulmonary infection, abdominal bleeding, anastomotic fistula, postoperative intestinal obstruction, and abdominal infection. There were 1, 5, and 2 patients with complications in grade Ⅰ, Ⅱ, and Ⅲ of Clavien-Dindo classification. There was no death in the postoperative 30 days. Two patients with abdominal bleeding were cured by intervene therapy, and patients with other complications were cured by conservative treatment. (3) Postoperative pathological examination: tumor diameter, cases with nodal or vascular or neural invasion, cases with differentiated and undifferentiated tumor (histological differentiation), cases in T1, T2, T3, T4 stages (T staging), cases in N0, N1, N2, N3 stages (N staging), cases in Ⅰ, Ⅱ, Ⅲ stages (TNM staging) were (4.2±1.6)cm, 26, 31, 16, 5, 22, 17, 3, 18, 9, 8, 12, 13, 20, 14, respectively. (4) Follow-up: 47 patients were followed up for 3-25 months, with a median time of 9 months. During the follow-up, 3 of 47 patients died of tumor recurrence, 1 had tumor-bearing survival, and 43 had tumor-free survival. Conclusion Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer is safe and feasible. Key words: Gastric neoplasms; Gastric cancer; Total gastrectomy; Spleen-preserving splenic hilar lymphadenectomy; Da Vinci robotic surgical system