系统评价机器人胃癌D2根治性淋巴结清扫术治疗胃癌的近期疗效。方法：检索中英文数据库，收集2011年1月—2020年12月发表的有关胃癌D2根治性淋巴结清扫术中机器人胃切除术（Robotic gastrectomy，RG）和腹腔镜胃切除术（Laparoscopic gastrectomy，LG）对比的文献，应用RevMan 5.4、Stata 16.0软件对纳入文献进行Meta分析。结果：最终纳入符合标准的相关研究共23篇，累计样本量6 140例，其中RG组2 491例，LG组

3 649例。Meta分析结果显示，与LG组比较，RG组手术时间更长（MD=20.91，95% CI：10.28~31.55，P<0.01），但术中出血量更少（MD=-31.16，95% CI：-40.84~-21.48，P<0.01），淋巴结清扫数量更多（MD=3.00，95% CI：1.73~4.28，P<0.01），术后住院时间更短（MD=-0.66，95% CI：-1.19~-0.14，P<0.05），术后首次排气时间缩短（MD=-0.28，95% CI：-0.41~-0.14，P<0.01），术后经口进食时间缩短（MD=-0.20，95% CI：-0.26~-0.14，P<0.01），术后总并发症发生率更低（OR=0.72，95% CI：0.61~0.84，P<0.01），术后并发症严重程度更低（OR=0.58，95% CI：0.43~0.79，P<0.001），术后吻合口漏发生率更低（OR=0.54，95% CI：0.33~0.88，P<0.05），手术切口长度更短（MD=-3.17，95% CI：-6.03~-0.30，P<0.05）；而两组术后切口感染、术后吻合口出血、术后肠梗阻、术后肺部感染、术后腹腔感染、肿瘤上切缘距离、肿瘤下切缘距离等指标比较，差异无统计学意义（P>0.05）。结论：机器人胃癌D2根治性淋巴结清扫术手术时间较腹腔镜手术时间长，在术中出血量、淋巴结清扫数量、术后住院时间数量、术后首次排气时间、术后经口进食时间、术后总并发症发生率、术后并发症严重程度、术后吻合口漏发生率方面均有较大优势，提示机器人胃癌D2淋巴结清扫术在近期疗效方面有较大优势，可以降低术后总并发症发生率及吻合口漏发生率，加快术后恢复，是一种安全、有效的手术方式。

To systematically evaluate the short-term efficacy of robotic D2 lymph node dissection for gastric cancer. Methods: Chinese and English databases were searched, and literatures on the comparison between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) on D2 dissection for gastric cancer published from January 2011 to December 2020 was collected. Using RevMan 5.4 and Stata16.0 software to conduct Meta analysis on the included literatures. Results: A total of 23 relevant studies that met the criteria were finally included, with a cumulative sample size of 6 140 cases, including 2 491 cases in the RG group and 3 649 cases in the LG group. Compared with LG group, meta-analysis result showed that RG group had longer operation time (MD=20.91, 95% CI: 10.28~31.55, P<0.01), less intraoperative blood loss (MD=-31.16, 95% CI: -40.84 ~ -21.48,P<0.01), more lymph node dissections (MD=3.00, 95% CI: 1.73~4.28, P<0.01), shorter postoperative hospital stay (MD=-0.66,95% CI: -1.19 ~ -0.14, P<0.05), shorter first postoperative exhaust time (MD=-0.28, 95%

 CI: -0.41~-0.14, P<0.01) andpostoperative oral feeding time (MD=-0.20, 95% CI: -0.26~-0.14, P<0.01). The overall postoperative complications rate of RG group was lower (OR=0.72, 95% CI: 0.61~0.84, P<0.01) with less severity (OR=0.58, 95% CI: 0.43~0.79, P<0.001), lower incidence of postoperative anastomotic leakage (OR=0.54, 95% CI: 0.33~0.88, P<0.05) and shorter incision length (MD=-3.17,

95% CI: -6.03 ~ -0.30, P<0.05). While differences on postoperative incision infection, postoperative anastomotic bleeding,

postoperative intestinal obstruction, postoperative pulmonary infection, postoperative abdominal infection, proximal resection

margin and distal resection margin were not statistically significant between the two groups (P>0.05). Conclusion: Robotic D2 lymph node dissection for gastric cancer takes longer than laparoscopic surgery. Robotic surgery has distinct advantages in terms of intraoperative blood loss, the number of lymph node dissection, postoperative hospital stay, first postoperative exhaust time, postoperative oral feeding time, total postoperative complications, severity of postoperative complications and incidence of postoperative anastomotic leakage, which suggest that robotic gastrectomy on D2 lymph node dissection for gastric cancer is superior to laparoscopic gastrectomy in terms of short-term efficacy. Robotic gastrectomy could reduce the overall postoperative complications and the incidence of anastomotic leakage and accelerate postoperative recovery, which is a safe and effective surgical method.

收稿日期：2021-07-15 录用日期：2021-12-06

Received Date: 2021-07-15 Accepted Date: 2021-12-06

基金项目：河南省医学科技攻关普通项目（201702175）

Foundation Item: General Project of Medical Science and Technology Research in Henan Province (201702175)

通讯作者：谢毅，Email：174171368@qq.com

Corresponding Author: XIE Yi, Email: 174171368@qq.com

引用格式：刘召，谢毅，朱含放. 机器人与腹腔镜行胃癌D2根治性淋巴结清扫术近期疗效对比的Meta分析[J]. 机器人外科学杂志（中英文），2022，3（4）：295-310.

Citation: LIU Z, XIE Y, ZHU H F. Meta-analysis on short-term curative effect between robotic and laparoscopic D2 radical lymph node dissection for gastric cancer[J]. Chinese Journal of Robotic Surgery, 2022, 3(4): 295-310.

[1] 曹毛毛, 陈万青. GLOBOCAN 2020 全球癌症统计数据解读[J]. 中国医学前沿杂志( 电子版), 2021,13(3): 63-69.

[2] CAO W, CHEN H D, YU Y W, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020[J]. Chin Med J (Engl), 2021, 134(7): 783-791.

[3] 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.

[4] 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.

[5] 李进权, 虞黎明, 赖斌, 等. 机器人系统及腹腔镜辅助行胃癌根治术治疗胃癌近期疗效对比Meta 分析[J]. 中国实用外科杂志, 2014, 34(12):1183-1188.

[6] 宋鹏, 王萌, 汪灏, 等. 机器人与腹腔镜胃癌D2 根治术近期疗效对比Meta 分析[J]. 腹部外科, 2016,29(1): 13-18.

[7] 楼茜洁, 刘芳腾, 潘华, 等. 机器人胃切除术与腹腔镜胃切除术治疗胃癌近期疗效的Meta 分析[J].实用临床医学, 2017, 18(11): 28-35.

[8] Isobe T, Murakami N, Minami T, et al. Robotic versus laparoscopic distal gastrectomy in patients with gastric cancer: a propensity score-matched analysis[J]. BMC Surg, 2021, 21(1): 203.

[9] 陈心足, 胡建昆. 胃癌规范化诊疗进展[J]. 华西医学, 2018, 33(4): 379-384.

[10] Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition)[J].Gastric Cancer, 2021, 24(1): 1-21.

[11] Uyama I, Kanaya S, Ishida Y, et al. Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience[J]. World J Surg, 2012, 36(2): 331-337.

[12] 张小磊, 江志伟, 赵坤. 手术机器人系统与腹腔镜辅助胃癌切除术的临床疗效对比[J]. 中华胃肠外科杂志, 2012, 15(8): 804-806.

[13] 刘驰. 达芬奇机器人与开腹及腹腔镜手术治疗胃癌的近期疗效对照研究[D]. 第三军医大学, 2013.

[14] 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.

[15] 刘江, 阮虎, 赵坤, 等. 达芬奇机器人与腹腔镜行胃癌根治术的对照研究[J]. 中华胃肠外科杂志, 2014,17(5): 461-464.

[16] Lee J, Kim Y M, Woo Y, et al. Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy[J]. Surg Endos

2015, 29(11): 3251-3260.

[17] Park J Y, Ryu K W, Reim D, et al. Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy?[J]. World J Surg, 2015, 39(7): 1789-1797.

[18] Cianchi F, Indennitate G, Trallori G, et al. Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative monoinstitutional study[J]. BMC Surg, 2016, 16(1): 65.

[19] Park J M, Kim H I, Han S U, et al. Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy[J]. Eur J Surg Oncol, 2016, 42(12): 1944-1949.

[20] PAN H F, WANG G, LIU J, et al. Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer[J]. Surg Laparosc Endosc Percutan Tech, 2017, 27(6): 428-433.

[21] 彭鸿. 机器人与腹腔镜远端胃癌根治术近期疗效对比分析[D]. 南昌大学, 2018.

[22] 李松岩, 宋林杰, 那兴邦, 等. 达芬奇机器人手术系统与腹腔镜辅助远端胃癌D2 根治Billroth 1 吻合术治疗胃癌效果比较[J]. 中华实用诊断与治疗杂

志, 2018, 32(3): 245-247.

[23] 申旭旗, 赵永亮, 苏崇宇, 等. 达芬奇机器人手术系统辅助与腹腔镜辅助局部进展期胃癌根治术近期疗效分析[J]. 中华消化外科杂志, 2018, 17(6): 581-587.

[24] 陈志新. 机器人与腹腔镜全胃切除术临床疗效对照研究[D]. 南昌大学, 2018.

[25] 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.

[26] 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.

[27] 杨昌东. 机器人与腹腔镜胃癌根治性全胃切除术近期疗效研究[D]. 中国人民解放军陆军军医大学,2019.DOI: 10.27001/d.cnki.gtjyu.2019.000087.

[28] 张珂诚, 曹博, 卫勃, 等. 机器人与腹腔镜辅助胃癌根治术中复杂部位淋巴结清扫对比研究[J]. 中国肿瘤临床, 2019 , 46(11): 546-550.

[29] 徐子鹏, 汪文杰, 熊诗萌, 等. 达芬奇机器人手术系统辅助胃癌根治术的临床疗效[J]. 中华消化外科杂志, 2019, 18(5): 453-458.

[30] YE S P, SHI J, LIU D N, et al. Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center[J]. Sci Rep, 2020, 10(1): 6502.

[31] Song J H, Son T, Lee S, et al. D2 lymph node dissections during reduced-port robotic distal subtotal gastrectomy and conventional laparoscopic surgery performed by a single surgeon in a high-volume center: a propensity score-matched analysis[J]. J Gastric Cancer, 2020,

20(4): 431-441.

[32] 崔昊, 刘国晓, 邓欢, 等. 机器人与3D 腹腔镜辅助远端胃癌D2 根治术近期疗效比较[J]. 中华胃肠外科杂志, 2020, 23(4): 350-356.

[33] 陈为凯, 张安, 吴金玲, 等. Clavien-Dindo 分级在达芬奇机器人手术系统和腹腔镜辅助全胃D2 根治术后近期并发症评估中的应用价值[J]. 中华消化外科杂志, 2020, 19(9): 976-982.

[34] HUANG K H, LAN Y T, FANG W L, et al. Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer[J]. PLoS One, 2014, 9(10): e111499.