Reports in the field of robotic surgery for gastric cancer are increasing. However, studies only on patients with advanced gastric cancer (AGC) are lacking. This retrospective study was to compare the short-term outcomes of robotic-assisted distal gastrectomy (RADG) and laparoscopic-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for AGC. From December 2014 to November 2019, 683 consecutive patients with AGC underwent mini-invasive assisted distal gastrectomy. Propensityscore matching (PSM) analysis was conducted to reduce patient selection bias. Short-term outcomes were compared between the two groups. The clinical features were well matched in the PSM cohort. Compared with the LADG group, the RADG group was associated with less operative blood loss, a lower rate of postoperative blood transfusion, less volume of abdominal drainage, less time to remove abdominal drainage tube, retrieved more lymph node, and lower rates of surgical complications and pancreatic fistula (P <0.05). However, the time to recovery bowel function, the length of postoperative stay, the rates of other subgroups of complications and unplanned readmission were similar between the two groups (P > 0.05). This study suggests that RADG is a safe and feasible technique with better short-term outcomes than LADG for AGC.Gastric cancer continues to be a major public health problem worldwide, especially in developing countries, such as China 1,2 . Every year, approximately 680,000 new patients are diagnosed with gastric cancer in China; among them, more than 80% of these patients have advanced-stage disease 1,3 . For patients with advanced gastric cancer (AGC), multidisciplinary comprehensive treatment is usually required, and gastrectomy with lymph node dissection is currently considered to be the only curable treatment 4 .In the past few decades, with the development of science and technology, much advanced surgical equipment has been invented, particularly in the field of mini-invasive surgery (MIS). Since laparoscopy-assisted Billroth I gastrectomy was first reported in 1994, several randomized controlled trials (RCTs) have demonstrated that laparoscopic gastrectomy (LG) for AGC is a safe and feasible technique with better short-term outcomes than and similar oncological outcomes to open gastrectomy [5][6][7][8][9] . Although LG has obtained greater acceptance among abdominal surgeons, because of the limitations of laparoscopic instruments, it is difficult to perform precisely, as is the case with D2 lymphadenectomy 10,11 .Robotic surgery systems, as another MIS method, were invented to overcome the drawbacks of laparoscopy and are becoming increasingly accepted by abdominal surgeons. Since Hashizume et al. first reported the use of robotic surgery for gastric cancer in 2002, a number of studies have shown the safety and advantages of robotic
Background Robotic-assisted surgery, a developed technology, is becoming more and more accepted by surgeons. However, the comparison between robotic-assisted total gastrectomy (RATG) and conventional laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC) is seldom reported, or usually the sample sizes reported are small. The current research was designed to compare the short-term outcomes of RATG and LATG with D2 lymphadenectomy for AGC in a mono-institution from China. Methods A total of 205 patients from June 2015 to October 2018 were included in this study. Among them, 106 patients underwent LATG, and 99 patients underwent RATG. The patients’ clinicopathological characteristics, surgical performance and short-term outcomes were retrospectively analyzed. Results The clinicopathological characteristics showed no difference between the LATG group and the RATG group. However, compared with the LATG group, the operation time was longer ( P = 0.000), and the operative blood loss ( P = 0.000) and the volume of abdominal drainage was less ( P = 0.000) in the RATG group. Moreover, the RATG took less time to remove abdominal drainage tube than LATG ( P = 0.000). The plasma levels of CRP at 72 h post-operation was lower ( P = 0.000), and the number of retrieved lymph nodes was more ( P = 0.000) in the RATG group. Nevertheless, the postoperative length of stay ( P = 0.890), the time to first flatus ( P = 0.448), the postoperative complication ( P = 0.915) and the visual analogue pain score at 24 h post-operation ( P = 0.457) were comparable between the two groups. Conclusions RATG with D2 lymphadenectomy shows safety and feasibility for AGC and could be served as an alternative treatment for AGC in the future.
BackgroundMetastasis is the main cause for gastric cancer (GC)-related deaths. Better understanding of GC metastatic mechanism would provide novel diagnostic markers and therapeutic targets. Though it has been reported that mammalian sterile-20-like kinase 4 (MST4) exerts the oncogenic role in other tumors, the prognostic value and biological role of MST4 in GC are still unknown.MethodsThe expression level of MST4 in GC was analyzed by using TCGA database. Then, Western blot and polymerase chain reaction (PCR) were used to determine the MST4 expression in GC tissues and cell lines. Immunohistochemistry was performed to investigate the expression of proteins in human GC tissues, and its correlation with clinicopathologic parameters as well as the prognosis for patients with GC was analyzed. In addition, the biological function and its molecular mechanism of MST4 in GC were investigated by in vitro and in vivo assays.ResultsIt demonstrated that MST4 expression was significantly upregulated in GC tissues and cell lines. High expression of MST4 was correlated with aggressive clinicopathological parameters such as lymph node metastasis, lymphovascular invasion (all P < 0.05). GC patients with high MST4 expression had both shorter overall survival (OS) and disease-free survival (DFS) than those with low MST4 expression (all P < 0.05). MST4 expression was an independent and significant risk factor for OS and DFS of GC patients (all P < 0.05). Results of functional experiments showed that MST4 could promote GC cells migration, invasion in vitro and metastasis in vivo. In terms of mechanism, MST4 promoted metastasis by facilitating epithelial–mesenchymal transition (EMT) through activating Ezrin pathway in GC. Further studies indicate that down-regulated miR-124-3p expression contributes to upregulated MST4 expression in GC.ConclusionOur data showed that MST4 predicts poor prognosis and promotes metastasis by facilitating epithelial–mesenchymal transition in GC. Therefore, our study suggests that MST4 can be used as a valuable prognostic biomarker and a potential therapeutic target in GC.
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