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Objective: To investigate and compare the abilities of robot-assisted gastrectomy (RAG) and laparoscopy-assisted gastrecto-my (LAG) to remove lymph nodes in technically demanding areas. Methods: Between August 2014 and August 2015, 61 patients who underwent RAG and 235 patients who underwent LAG were enrolled in this study. Clinical characteristics, operative parameters, and pathological and oncological data were collected prospectively, and the numbers of retrieved lymph nodes for each station were ana-lyzed in accordance with the extent of surgery. Results: More lymph nodes were retrieved in the RAG group than in the LAG group (P=0.046). Similarly, the RAG group had more retrieved lymph nodes in the N2 area (P=0.038). In patients who underwent distal gastrecto- my, the numbers of retrieved lymph nodes around the splenic artery area using RAG and LAG were 2.8±1.7 and 2.2±1.2, respectively (P=0.036). In patients who underwent total gastrectomy, 2.8±1.2 and 2.1±1.0 lymph nodes were retrieved with RAG and LAG around the splenic artery area, respectively (P=0.049). The mean numbers of lymph nodes retrieved around the splenic hilum were 1.8±0.8 and 1.3±0.7, respectively (P=0.042). The intraoperative blood transfusion rate (P=0.617), postoperative hospital days (P=0.071), proxi-mal resection margin (P=0.064), and distal resection margin (P=0.667) were not significantly different between the two groups. The numbers of postoperative complications were also similar between the RAG and LAG groups (P=0.854). However, RAG had less severe complications according to the Clavien-Dindo classification (P=0.039). Conclusions: This study demonstrated that RAG had advantages over LAG regarding lymph node dissection in technically demanding areas and might contribute to radical D2 lymphadenectomy with less severe complications.
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Objective To compare the clinical effects of remifentanil combined with sevoflurane or with isoflurane in elderly patients undergoing radical gastrectomy for cancer and their recovery.Methods Sixty-two patients,who scheduled for radical gastrectomy for cancer was randomly divided into remifentanil combined with sevoflurane group ( SR group,n =31 ) and remifentanil combined with isoflurane group ( IR group,n =31 ).They were classified into American Society of Anesthesiology(ASA) physical status Ⅱ and ,The procedure of two Anesthesia was same,in which remifentanil was continually pumped into at the same velocity using micro pump immediately after intubation,tili the target density in plasma increased to 6 μg/L.Sevoflurane at 1.5％ to 2.0％ was inhaled in the SR group,whereas isoflurane at 1％ to 2％ in the IR group.The inhalation was ended at 5 mins before the surgery was completed,Remifentanil was stopped while stuturing,and 0.1 mg of Remifentanil was injected at 20 mins before the surgery was completed.The heart rate(HR) and blood pressure were recorded at before induction of anesthesia (T0),after induction of anesthesia ( T1 ),immediate intubation ( T2 ),surgery after the start of 5 min ( T3 ),30 min (T4) and the time of surgery ( T5 ),respectively.The recovery time and extubation time,and quality score for awakening after extubation (OAAS) were also recorded.Results There were no significant differences in HR,SBP and DBP at every time points observed between the two groups.The recovery time( 10.4 ± 3.9)mins and extubation time(5.9 ± 3.1 )min in SR group was significantly shorter than that of(16.3 ± 5.8) min and (9.7 ±2.5) min in the IR group(t =6.25 and 4.19,P =0.02 and 0.01,respectively ).The OAAS after extubation in the two groups gradually increased,and immediately after extubation and extubation after 10 min,OAAS in the SR group was(4.1 ± 1.2),which was significantly higher than that of (2.9±1.0)in the IR group(t =3.27,P =0.03).Conclusion Either stevoflurane-remifentanil or isoflurane remifentanil anesthesia can be used safely in elderly patients undergoing radical gastrectomy for cancer.Anesthesia with Sevoflurane-remifentanil provides better faster recovery than isoflurane- remifentanil in elderly patients.