Abstract：
BACKGROUND: Pelvic exenteration (PE) is the last resort for achieving a complete cure for pelvic cancer; however, it is burdensome for patients. Minimally invasive surgeries, including robot-assisted surgery, have been widely used to treat malignant tumors and have also recently been used in PE. This study aimed to evaluate the safety and efficacy of robot-assisted PE (RPE) by comparing the outcomes of open PE (OPE) with those of conventional laparoscopic PE (LPE) for treating pelvic tumors.
METHODS: Following the ethics committee approval, a multicenter retrospective analysis of patients who underwent pelvic exenteration between January 2012 and October 2022 was conducted. Data on patient demographics, tumor characteristics, and perioperative outcomes were collected. A 1:1 propensity score-matched analysis was performed to minimize group selection bias.
RESULTS: In total, 261 patients met the study criteria, of whom 61 underwent RPE, 90 underwent OPE, and 110 underwent LPE. After propensity score matching, 50 pairs were created for RPE and OPE and 59 for RPE and LPE. RPE was associated with significantly less blood loss (RPE vs. OPE: 408 mL vs. 2385 ml, p < 0.001), lower transfusion rate (RPE vs. OPE: 32% vs. 82%, p < 0.001), and lower rate of complications over Clavien-Dindo grade II (RPE vs. OPE: 48% vs. 74%, p = 0.013; RPE vs. LPE: 48% vs. 76%, p = 0.002).
CONCLUSIONS: This multicenter study suggests that RPE reduces blood loss and transfusion compared with OPE and has a lower rate of complications compared with OPE and LPE in patients with locally advanced and recurrent pelvic tumors.
METHODS: Following the ethics committee approval, a multicenter retrospective analysis of patients who underwent pelvic exenteration between January 2012 and October 2022 was conducted. Data on patient demographics, tumor characteristics, and perioperative outcomes were collected. A 1:1 propensity score-matched analysis was performed to minimize group selection bias.
RESULTS: In total, 261 patients met the study criteria, of whom 61 underwent RPE, 90 underwent OPE, and 110 underwent LPE. After propensity score matching, 50 pairs were created for RPE and OPE and 59 for RPE and LPE. RPE was associated with significantly less blood loss (RPE vs. OPE: 408 mL vs. 2385 ml, p < 0.001), lower transfusion rate (RPE vs. OPE: 32% vs. 82%, p < 0.001), and lower rate of complications over Clavien-Dindo grade II (RPE vs. OPE: 48% vs. 74%, p = 0.013; RPE vs. LPE: 48% vs. 76%, p = 0.002).
CONCLUSIONS: This multicenter study suggests that RPE reduces blood loss and transfusion compared with OPE and has a lower rate of complications compared with OPE and LPE in patients with locally advanced and recurrent pelvic tumors.
摘要：
背景：盆腔切除术（PE）是实现盆腔癌完全治愈的最后手段；然而，这对病人来说是沉重的负担。微创手术，包括机器人辅助手术，已广泛用于治疗恶性肿瘤，最近也已用于PE。本研究旨在通过比较开放式PE（OPE）与传统腹腔镜PE（LPE）治疗盆腔肿瘤的结果来评估机器人辅助PE（RPE）的安全性和有效性。
方法：在伦理委员会批准后，本研究对2012年1月至2022年10月期间接受盆腔切除术的患者进行了多中心回顾性分析.患者人口统计数据，肿瘤特征，收集围手术期结局。进行1：1倾向得分匹配分析，以最大程度地减少组选择偏倚。
结果：总计，261名患者符合研究标准，其中61人接受了RPE，90接受了OPE，110例接受LPE。在倾向得分匹配后，为RPE和OPE创建了50对，为RPE和LPE创建了59对。RPE与明显减少的失血相关（RPE与OPE：408mLvs.2385毫升，p<0.001)，较低的输血率（RPE与OPE：32％与82%,p<0.001)，与Clavien-DindoII级相比，并发症发生率较低(RPE与OPE：48％与74%,p=0.013;RPEvs.LPE：48%与76%,p=0.002)。
结论：这项多中心研究表明，在局部晚期和复发性盆腔肿瘤患者中，与OPE和LPE相比，RPE减少了失血和输血，并发症发生率低于OPE和LPE。
方法：在伦理委员会批准后，本研究对2012年1月至2022年10月期间接受盆腔切除术的患者进行了多中心回顾性分析.患者人口统计数据，肿瘤特征，收集围手术期结局。进行1：1倾向得分匹配分析，以最大程度地减少组选择偏倚。
结果：总计，261名患者符合研究标准，其中61人接受了RPE，90接受了OPE，110例接受LPE。在倾向得分匹配后，为RPE和OPE创建了50对，为RPE和LPE创建了59对。RPE与明显减少的失血相关（RPE与OPE：408mLvs.2385毫升，p<0.001)，较低的输血率（RPE与OPE：32％与82%,p<0.001)，与Clavien-DindoII级相比，并发症发生率较低(RPE与OPE：48％与74%,p=0.013;RPEvs.LPE：48%与76%,p=0.002)。
结论：这项多中心研究表明，在局部晚期和复发性盆腔肿瘤患者中，与OPE和LPE相比，RPE减少了失血和输血，并发症发生率低于OPE和LPE。
