胃癌发病率、死亡率高，根治性手术仍是胃癌治疗的核心。随着微创外科的不断发展，腹腔镜下胃癌根治术的安全性、有效性及良好的预后已被证实。机器人手术技术的出现在减少术中出血、术后并发症及改善术后生活质量等方面具有优势，但也存在技术缺陷、费用昂贵及预后争议等不足。本文就达芬奇机器人系统在胃癌根治术中的应用现状与最新进展进行综述。

People are seriously threatened by gastric cancer due to its high morbidity and mortality. While radical surgery is still the key to the treatment of gastric cancer. With the development of minimally invasive surgery, the safety, effectiveness and good prognosis of laparoscopic gastrectomy for gastric cancer have been confirmed. The newly emerged robotic surgery system has advantages on reducing intraoperative bleeding, postoperative complications and improving postoperative quality of life, but it also faces technical defects, high cost, controversial prognosis, and other shortcomings. This paper aims to review the application status and latest progress of Da Vinci surgical system in radical resection for gastric cancer.

收稿日期：2021-05-02  录用日期：2021-07-19

Received Date: 2021-05-02  Accepted Date: 2021-07-19

基金项目：甘肃省外科肿瘤分子诊断与精准治疗重点实验室开放基金（2019GSZDSYS06）

Foundation Item: Open Foundation of Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in

Gansu Province (2019GSZDSYS06)

通讯作者：杨婧，Email：21634604@qq.com

Corresponding Author: YANG Jing, Email: 21634604@qq.com

引用格式：靳川伟，马云涛，杨婧 . 达芬奇机器人手术系统“3+X”模式在胃癌根治术中的应用现状 [J]. 机器人外科学杂志（中英文），2021，2（6）：492-499.

Citation: JIN C W, MA Y T, YANG J. Application status of Da Vinci robotic surgical system“3+X” mode in radical resection for gastric cancer [J]. Chinese Journal of Robotic Surgery, 2021, 2 (6): 492-499.

[1] Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021. DOI: 10.3322/caac.21660.

[2] ZHANG S, SUN K, ZHENG R, et al. Cancer incidence and mortality in China, 2015[J]. Journal of the National Cancer Center, 2021, 1(1): 2-11.

[3] YU J, HUANG C, SUN Y, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the class-01 randomized clinical trial[J]. JAMA, 2019, 321(20): 1983-1992.

[4] Kim H H, Han S U, Kim M C, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage Ⅰ gastric cancer: the klass-01 randomized clinical trial[J]. JAMA Oncol, 2019, 5(4): 506-513.

[5] Katai H, Mizusawa J, Katayama H, et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2020, 5(2): 142-151.

[6] Lee H J, Hyung W J, Yang H K, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT)[J]. Ann Surg, 2019, 270(6): 983-991.

[7] Hashizume M, Shimada M, Tomikawa M, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system[J]. Surg Endosc, 2002, 16(8): 1187-1191.

[8] 余佩武 , 罗华星 . 机器人胃癌外科手术的现状与趋势 [J]. 中国普外基础与临床杂志 , 2017, 24(04): 397-399.

[9] WANG W J, LI H T, YU J P, et al. Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study[J]. Surg Endosc, 2019, 33(10): 3341-3354.

[10] Bobo Z, Xin W, Jiang L, et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies[J]. Surg Endosc, 2019, 33(4): 1033-1048.

[11] Obama K, Kim Y M, Kang D R, et al. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy[J]. Gastric Cancer, 2018, 21(2): 285-295.

[12] Kim Y W, Reim D, Park J Y, et al. Role of robotassisted distal gastrectomy compared to laparoscopyassisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer[J]. Surg Endosc, 2016, 30(4): 1547-1552.

[13] Liao G, Zhao Z, Khan M, et al. Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients[J]. World J Surg Oncol, 2019, 17(1): 86.

[14] 丛霆 , 刘国晓 , 张珂诚 , 等 . 机器人和腹腔镜辅助根治性全胃切除术在体质指数高于正常值胃癌患者中的应用 [J]. 中华胃肠外科杂志 , 2018, 21(3): 318-324.

[15] 中国研究型医院学会机器人与腹腔镜外科专业委员会 . 机器人胃癌手术专家共识 (2015 版 )[J]. 中华消化外科杂志 , 2016, 15(1): 7-11.

[16] Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4)[J]. Gastric Cancer, 2017, 20(1): 1-19.

[17] Cianchi F, Indennitate G, Trallori G, et al. Robotic v s laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study[J]. BMC Surg, 2016, 16(1): 65.

[18] Son T, Lee J H, Kim Y M, et al. Robotic spleenpreserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure[J]. Surg Endosc, 2014, 28(9): 2606-2615.

[19] SUN L F, LIU K, SU X S, et al. Robot-assisted versus laparoscopic-assisted gastrectomy among gastric cancer patients: a retrospective short-term analysis from a single institution in China[J]. Gastroenterol Res Pract, 2019. DOI: 10.1155/2019/9059176.

[20] LI Z, LI J, LI B, et al. Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis[J]. Cancer Manag Res, 2018. DOI: 10.2147/ CMAR.S161007.

[21] Ojima T, Nakamura M, Nakamori M, et al. Robotic radical lymphadenectomy without touching the pancreas during gastrectomy for gastric cancer[J]. Medicine (Baltimore), 2019, 98(13): e15091.

[22] CHEN Q Y, ZHONG Q, ZHENG C H, et al. Robotic spleen-preserving splenic hilar lymphadenectomy for advanced proximal gastric cancer: a feasible and simplified procedure[J]. Surg Oncol, 2019. DOI: 10.1016/J.suronc.2018.11.014.

[23] 余佩武 , 罗华星 . 达芬奇机器人在胃肠手术中的 应用与发展 [J]. 中华普外科手术学杂志 ( 电子版 ), 2017, 11(1): 1-4.

[24] 季加孚 , 季鑫 . 胃癌根治术后消化道重建的原则与 进展 [J]. 中华普外科手术学杂志 ( 电子版 ), 2014, 8(4): 285-288.

[25] Tsai S H, Liu C A, Huang K H, et al. Advances in laparoscopic and robotic gastrectomy for gastric cancer[J]. Pathol Oncol Res, 2017, 23(1): 13-17.

[26] WANG G, JIANG Z, ZHAO J, et al. Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer: a randomized clinical trial[J]. J Surg Oncol, 2016, 113(4): 397-404.

[27] Uyama I, Suda K, Nakauchi M, et al. Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective singlearm study[J]. Gastric Cancer, 2019, 22(2): 377-385.

[28] CHEN Q Y, ZHONG Q, LIU Z Y, et al. Surgical outcomes, technical performance and surgery burden

of robotic total gastrectomy for locally advanced gastric cancer: a prospective study[J]. Ann Surg, 2021. DOI: 10.1097/SLA.0000000000004764.

[29] Roh C K, Choi S, Seo W J, et al. Comparison of surgical outcomes between integrated robotic and conventional laparoscopic surgery for distal gastrectomy: a propensity score matching analysis[J]. Sci Rep, 2020, 10(1): 485.

[30] HU M, HAN C, GUO T, et al. Application of da Vinci robot with the”3+2” mode in radical gastrectomy for gastric cancer[J]. Medicine (Baltimore), 2020, 99(46): e22988.

[31] 狐鸣 , 韩彩文 , 郭天康 , 等 . 达芬奇机器人“3+2”模式在胃癌根治术中的安全性和有效性研究 [J]. 中华普通外科杂志 , 2019, 34(10):855-858.

[32] JIANG Y, ZHAO Y, QIAN F, et al. The long-term clinical outcomes of robotic gastrectomy for gastric cancer: a large-scale single institutional retrospective study[J]. Am J Transl Res, 2018, 10(10): 3233-3242.

[33] 李政焰 , 石彦 , 赵永亮 , 等 . 腹腔镜与开腹进展期远端胃癌 D2 根治术疗效对比 [J]. 中华胃肠外科杂 志 , 2016, 19(05): 530-534.

[34] GAO Y, XI H, QIAO Z, et al. Comparison of robotic-and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short-and long-term results[J]. Surg Endosc, 2019, 33(2): 528-534.

[35] Shin H J, Son S Y, Wang B, et al. Long-term Comparison of robotic and laparoscopic gastrectomy for gastric cancer: a propensity score-weighted analysis靳of 2084 consecutive patients[J]. Ann Surg, 2020. DOI: 10.1097/SLA.0000000000003845.

[36] QIU H, AI J H, SHI J, et al. Effectiveness and safety of robotic versus traditional laparoscopic gastrectomy for gastric cancer: an updated systematic review and metaanalysis[J]. J Cancer Res Ther, 2019, 15(7): 1450-1463.

[37] CHEN K, PAN Y, ZHANG B, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and updated meta-analysis[J]. BMC Surg, 2017, 17(1): 93.

[38] KONG Y, CAO S, LIU X, et al. Short-term clinical outcomes after laparoscopic and robotic gastrectomy for gastric cancer: a propensity score matching analysis[J]. J Gastrointest Surg, 2020, 24(3): 531-539.

[39] Liu H, Kinoshita T, Tonouchi A, et al. What are the reasons for a longer operation time in robotic gastrectomy than in laparoscopic gastrectomy for stomach cancer?[J]. Surg Endosc, 2019, 33(1): 192-198.

[40] 余佩武 , 李政焰 . 中国胃癌机器人手术开展的现状与思考 [J]. 中华胃肠外科杂志 , 2020, 23(4): 332-333.

[41] LU J, ZHENG C H, XU B B, et al. Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial[J]. Ann Surg, 2021, 273(5): 858-867.