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Abstract：
UNASSIGNED: During the past decade, the concept of complete mesocolic excision (CME) has been developed in an attempt to minimize recurrence for right-sided colon cancer. This study aims to compare outcomes of robotic versus laparoscopic right hemicolectomy with CME for right-sided colon cancer.
UNASSIGNED: We performed a retrospective multicenter propensity score matching study. From July 2016 to July 2021, 382 consecutive patients from different Chinese surgical departments were available for inclusion out of an initial cohort of 412, who underwent robotic or laparoscopic right hemicolectomy with CME. Data of all patients were retrospectively collected and reviewed. Of these, 149 cases were performed by a robotic approach, while the other 233 cases were done by laparoscopy. Propensity score matching was applied at a ratio of 1:1 to compare perioperative, pathologic, and oncologic outcomes between the robotic and the laparoscopic groups (n = 142).
UNASSIGNED: Before propensity score matching, there were no statistical differences regarding the sex, history of abdominal surgery, body mass index (BMI), American Joint Committee on Cancer (AJCC) staging system, tumor location, and center between groups (p > 0.05), while a significant difference was observed regarding age (p = 0.029). After matching, two comparable groups of 142 cases were obtained with equivalent patient characteristics (p > 0.05). Blood loss, time to oral intake, return of bowel function, length of stay, and complications were not different between groups (p > 0.05). The robotic group showed a significantly lower conversion rate (0% vs. 4.2%, p = 0.03), but a longer operative time (200.9 min vs. 182.3 min, p < 0.001) and a higher total hospital cost (85,016 RMB vs. 58,266 RMB, p < 0.001) compared with the laparoscopic group. The number of harvested lymph nodes was comparable (20.4 vs. 20.5, p = 0.861). Incidence of complications, mortality, and pathologic outcomes were similar between groups (p > 0.05). The 2-year disease-free survival rates were 84.9% and 87.1% (p = 0.679), and the overall survival rates between groups were 83.8% and 80.7% (p = 0.943).
UNASSIGNED: Despite the limitations of a retrospective analysis, the outcomes of robotic right hemicolectomy with CME were comparable to the laparoscopic procedures with fewer conversions to open surgery. More clinical advantages of the robotic surgery system need to be further confirmed by well-conducted randomized clinical trials with large cohorts of patients.
UNASSIGNED: We performed a retrospective multicenter propensity score matching study. From July 2016 to July 2021, 382 consecutive patients from different Chinese surgical departments were available for inclusion out of an initial cohort of 412, who underwent robotic or laparoscopic right hemicolectomy with CME. Data of all patients were retrospectively collected and reviewed. Of these, 149 cases were performed by a robotic approach, while the other 233 cases were done by laparoscopy. Propensity score matching was applied at a ratio of 1:1 to compare perioperative, pathologic, and oncologic outcomes between the robotic and the laparoscopic groups (n = 142).
UNASSIGNED: Before propensity score matching, there were no statistical differences regarding the sex, history of abdominal surgery, body mass index (BMI), American Joint Committee on Cancer (AJCC) staging system, tumor location, and center between groups (p > 0.05), while a significant difference was observed regarding age (p = 0.029). After matching, two comparable groups of 142 cases were obtained with equivalent patient characteristics (p > 0.05). Blood loss, time to oral intake, return of bowel function, length of stay, and complications were not different between groups (p > 0.05). The robotic group showed a significantly lower conversion rate (0% vs. 4.2%, p = 0.03), but a longer operative time (200.9 min vs. 182.3 min, p < 0.001) and a higher total hospital cost (85,016 RMB vs. 58,266 RMB, p < 0.001) compared with the laparoscopic group. The number of harvested lymph nodes was comparable (20.4 vs. 20.5, p = 0.861). Incidence of complications, mortality, and pathologic outcomes were similar between groups (p > 0.05). The 2-year disease-free survival rates were 84.9% and 87.1% (p = 0.679), and the overall survival rates between groups were 83.8% and 80.7% (p = 0.943).
UNASSIGNED: Despite the limitations of a retrospective analysis, the outcomes of robotic right hemicolectomy with CME were comparable to the laparoscopic procedures with fewer conversions to open surgery. More clinical advantages of the robotic surgery system need to be further confirmed by well-conducted randomized clinical trials with large cohorts of patients.
摘要：
■在过去的十年中，完全结肠系膜切除术(CME)的概念已被提出,以尽量减少右侧结肠癌的复发.这项研究旨在比较机器人与腹腔镜右半结肠切除术与CME治疗右侧结肠癌的结果。
■我们进行了一项回顾性多中心倾向评分匹配研究。从2016年7月至2021年7月，从最初的412名队列中纳入了来自中国不同外科部门的382名连续患者，他们接受了CME机器人或腹腔镜右半结肠切除术。对所有患者的资料进行回顾性分析。其中,149例通过机器人方法进行，其余233例采用腹腔镜检查。倾向评分匹配以1:1的比例应用于比较围手术期，病理性,机器人组和腹腔镜组之间的肿瘤学结果（n=142）。
■在倾向得分匹配之前，性别没有统计学差异，腹部手术史,体重指数（BMI），美国癌症联合委员会（AJCC）分期系统，肿瘤位置,组间居中(p>0.05)，而在年龄方面观察到显着差异（p=0.029）。匹配后,两组具有可比性的142例患者均具有相同的患者特征（p>0.05）。失血,口服时间，肠道功能恢复,逗留时间,两组并发症无明显差异(p>0.05)。机器人组的转化率明显较低(0%vs.4.2%，p=0.03),但手术时间更长(200.9分钟vs.182.3分钟,p<0.001）和更高的医院总费用（85,016元人民币与58,266元，p<0.001)与腹腔镜组比拟。收集的淋巴结数量相当（20.4与20.5，p=0.861）。并发症的发生率，死亡率,两组间病理结果相似(p>0.05)。2年无病生存率分别为84.9%和87.1%(p=0.679),两组总生存率分别为83.8%和80.7%(p=0.943)。
■尽管回顾性分析有局限性，采用CME的机器人右半结肠切除术的结果与腹腔镜手术相媲美,但转换为开腹手术的次数较少.机器人手术系统的更多临床优势需要通过对大量患者进行良好的随机临床试验来进一步证实。
■我们进行了一项回顾性多中心倾向评分匹配研究。从2016年7月至2021年7月，从最初的412名队列中纳入了来自中国不同外科部门的382名连续患者，他们接受了CME机器人或腹腔镜右半结肠切除术。对所有患者的资料进行回顾性分析。其中,149例通过机器人方法进行，其余233例采用腹腔镜检查。倾向评分匹配以1:1的比例应用于比较围手术期，病理性,机器人组和腹腔镜组之间的肿瘤学结果（n=142）。
■在倾向得分匹配之前，性别没有统计学差异，腹部手术史,体重指数（BMI），美国癌症联合委员会（AJCC）分期系统，肿瘤位置,组间居中(p>0.05)，而在年龄方面观察到显着差异（p=0.029）。匹配后,两组具有可比性的142例患者均具有相同的患者特征（p>0.05）。失血,口服时间，肠道功能恢复,逗留时间,两组并发症无明显差异(p>0.05)。机器人组的转化率明显较低(0%vs.4.2%，p=0.03),但手术时间更长(200.9分钟vs.182.3分钟,p<0.001）和更高的医院总费用（85,016元人民币与58,266元，p<0.001)与腹腔镜组比拟。收集的淋巴结数量相当（20.4与20.5，p=0.861）。并发症的发生率，死亡率,两组间病理结果相似(p>0.05)。2年无病生存率分别为84.9%和87.1%(p=0.679),两组总生存率分别为83.8%和80.7%(p=0.943)。
■尽管回顾性分析有局限性，采用CME的机器人右半结肠切除术的结果与腹腔镜手术相媲美,但转换为开腹手术的次数较少.机器人手术系统的更多临床优势需要通过对大量患者进行良好的随机临床试验来进一步证实。
