Systemic Immune-Inflammatory Index For Evaluating Robotic and Laparoscopic Proximal Gastrectomy in Upper Gastric Cancer

Summary

This protocol evaluates postoperative systemic immune-inflammatory responses and perioperative recovery outcomes after robotic and laparoscopic proximal gastrectomy in patients with upper gastric cancer using systemic immune-inflammatory index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio measurements.

Abstract

Tumor resection is a commonly used treatment method in clinical practice. With the increasing refinement of tumor surgery, the application of robotic-assisted surgery in clinical procedures has expanded. However, effective indicators for evaluating surgical efficacy and postoperative prognosis remain limited. This study introduced the systemic immune-inflammatory index (SII) to evaluate perioperative inflammatory responses and postoperative recovery following robotic and conventional laparoscopic surgery. A total of 81 patients who underwent robotic-assisted gastrointestinal tumor resection and 81 patients who underwent conventional laparoscopic gastrointestinal tumor resection were included. SII was calculated using the formula: platelet count × (neutrophil count/lymphocyte count). Postoperative SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) increased after surgery, peaked on postoperative day 3, and gradually returned toward baseline by postoperative day 7. From postoperative day 3 onward, SII and NLR values in the robotic surgery group were significantly lower than those in the laparoscopic surgery group (P < 0.05), and these differences remained significant on postoperative days 5 and 7 (P < 0.05). PLR values were significantly lower in the robotic surgery group on postoperative day 3 only (P < 0.05), whereas no significant differences were observed on postoperative days 5 or 7 (P > 0.05). Patients in the robotic surgery group also demonstrated improved postoperative recovery indicators, including earlier ambulation, earlier postoperative exhaust and feeding, lower average drainage volume and shorter postoperative hospital stay. These findings suggest that SII may serve as a useful indicator for evaluating postoperative inflammatory status and perioperative recovery following minimally invasive gastric cancer surgery.

Introduction

Gastric cancer remains one of the leading causes of cancer-related mortality worldwide and represents a major public health burden in China¹. The development and progression of gastric cancer are associated with multiple factors, including dietary habits, environmental exposure, and lifestyle-related risk factors^2,3,4. Current treatment strategies for gastric cancer commonly involve multimodal management, including neoadjuvant therapy, surgical resection, and adjuvant chemotherapy, depending on tumor stage and patient condition⁵....

Protocol

The testing data of all patients pathologically diagnosed with gastric adenocarcinoma were obtained from the laboratory database collected between 2024 and 2025 at the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University. Upper gastric cancer was defined as tumors located in the upper third of the stomach or esophagogastric junction. We retrospectively analyzed the collected data. The samples were deidentified prior to use and were processed in compliance with approved institutional protocols approved by the Ethics Committee of the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University (KY-2024-250-01). Written informed consent was ....

Results

Comparison of surgical steps and surgical details between the conventional laparoscopic surgery group and the robotic-assisted surgery group

As shown in Figure 1, statistical analysis of operative parameters demonstrated that the robotic-assisted surgery group required a longer reconstruction time than the laparoscopic surgery group (P < 0.05). However, the robotic-assisted approach was associated with significantly lower estimated int.......

Discussion

Gastric cancer is associated with high morbidity and mortality worldwide, and its incidence remains a major public health concern^19,20. With the continuous development of diagnostic and therapeutic technologies, particularly advances in surgical treatment, the management of gastric cancer has improved substantially²¹. Therefore, further evaluation of minimally invasive surgical approaches for gastric cancer remains clinically important. In.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Absorbable sutures	Ethicon, Cincinnati, OH, USA	SXMD1B405	Anastomotic reinforcement and fixation
Automated hematology analyzer	Sysmex, Kobe, Japan	XN-2800	Peripheral blood cell analysis
Carbon dioxide insufflator	Olympus, Tokyo, Japan	UHI system	Pneumoperitoneum establishment
Circular stapler	Johnson & Johnson, New Brunswick, NJ, USA	EEA	Esophagogastric anastomosis
EDTA-K2 anticoagulant blood collection tubes	WEGO, Weihai, China	20260101	Peripheral blood sample collection
Endoscopic linear stapler	Ethicon, Cincinnati, OH, USA	ECH60C	Gastric transection and reconstruction
Energy device for tissue dissection	Ethicon, Cincinnati, OH, USA	Harmonic 1100	Tissue dissection and hemostasis
Presentation software	Microsoft, Redmond, WA, USA	PowerPoint	Figure preparation, annotation, and data visualization
Laparoscopic camera system	Karl Storz, Tuttlingen, Germany	TC200	Intraoperative visualization
Laparoscopic surgical system	Karl Storz, Tuttlingen, Germany	26605AA	Conventional minimally invasive surgery
Nasogastric tube	Huacheng, Guangzhou, China	16 Fr	Gastric decompression
Needle holder	Olympus, Tokyo, Japan	A5690	Intracorporeal suturing
Nonabsorbable sutures	Ethicon, Cincinnati, OH, USA	Mersilke	Tissue fixation
Pathology specimen container	Cidabio, Guangzhou, China	Bio-CD2492	Surgical specimen collection
Personal protective equipment	3M, St. Paul, MN, USA	4565	Surgical safety and biosafety compliance
Robotic-assisted surgical system	Intuitive Surgical, Sunnyvale, CA, USA	Da Vinci Xi IS4000	Robotic-assisted minimally invasive surgery
Statistical analysis software	GraphPad Software, San Diego, CA, USA	GraphPad Prism 8.0	Statistical analysis
Statistical analysis software	IBM Corp., Armonk, NY, USA	SPSS 17.0	Statistical analysis
Surgical forceps and graspers	Olympus, Tokyo, Japan	A63010S	Tissue manipulation
Surgical trocars	AOFO/Intuitive Surgical	FQ/Cannula	Port placement during surgery