[Application of robotic surgery to treat carcinoma in the remnant stomach].

OBJECTIVE: To explore the surgical techniques and feasibility of robotic surgery for carcinoma in the remnant stomach(CRS).

METHODS: Clinicopathological data of 20 CRS patients undergoing robotic surgery at the Minimally Invasive Center for Gastrointestinal Surgery, Army Medical University Southwest Hospital from November 2012 to October 2017 were retrospectively collected. The surgical methods, procedures, main difficulties, and key techniques were analyzed, and the clinical efficacy was evaluated.

RESULTS: Among 20 CRS patients, 14 were male and 6 were female with mean age of 59.9 years and mean BMI of 19.7 kg/m2 . For the primary diseases, 17 patients underwent laparotomy, 3 underwent laparoscopic radical resection of gastric cancer; 18 cases received distal subtotal gastrectomy plus Billroth II( anastomosis, 2 received distal subtotal gastrectomy plus Billroth I( anastomosis. CRS located in anastomotic stoma in 15 cases and in the gastric fundus and cardiac part in 5 cases. Preoperative staging revealed 2 cases of T2NxM0, 1 of T3NxM0, 2 of TxNxM0 and 15 of T4aNxM0. Sixteen patients received robotic surgery with Roux-en-Y reconstruction successfully, and 4 patients were converted to laparotomy for palliative total gastrectomy, including 1 case with diaphragm invasion, 1 case with transverse colon invasion, and 2 cases with tight adhesions. The mean surgery time was (255±35) minutes, mean blood loss was (230±50) ml, mean number of dissected lymph nodes was 19.5±3.0, mean recovery time to gastrointestinal function was (2.3±1.0) days, mean time to feeding was (2.3±1.0) days, and mean time to ambulatory activity was (2.5±0.5) days. Pathological examinations revealed 12 patients with poorly differentiated adenocarcinoma, 6 patients with moderately differentiated adenocarcinoma, and 2 patients with mucinous adenocarcinoma. Postoperative pTNM staging was identified as follows: stage I(B for 1 patient, stage II(A for 2 patients, stage II(B for 5 patients, stage III(A for 5 patients, stage III(B for 4 patients, and stage III(C for 3 patients. One patient died 2 weeks after operation due to multiple organ failure. One patient received another hemostasis operation due to hemorrhage of splenic artery and recovered postoperatively. Two patients experienced anastomotic leakage, 1 patient developed duodenal stump fistula and 1 patient experienced incision site infection postoperatively, and all of them recovered after conservative treatment. During 5-60 months follow-up, 10 cases died and 10 cases survived, including 1 case for 6 years.

CONCLUSIONS: Robotic surgery for CRS is feasible with satisfactory short-term efficacy. However, the long-term efficacy requires further study.