Abstract：
BACKGROUND: Despite widespread adoption of robotic-assisted surgery (RAS) in rectal cancer resection, there remains limited knowledge of its clinical advantage over laparoscopic (Lap) and open (OS) surgery. We aimed to compare clinical outcomes of RAS with Lap and OS for rectal cancer.
METHODS: We identified all patients aged ≥ 18 years who had elective rectal cancer resection requiring temporary or permanent stoma formation from 1/2013 to 12/2020 from the PINC AI™ Healthcare Database. We completed multivariable logistic regression analysis accounting for hospital clustering to compare ileostomy formation between surgical approaches. Next, we built inverse probability of treatment-weighted analyses to compare outcomes for ileostomy and permanent colostomy separately. Outcomes included postoperative complications, in-hospital mortality, discharge to home, reoperation, and 30-day readmission.
RESULTS: A total of 12,787 patients (OS: 5599 [43.8%]; Lap: 2872 [22.5%]; RAS: 4316 [33.7%]) underwent elective rectal cancer resection. Compared to OS, patients who had Lap (OR 1.29, p < 0.001) or RAS (OR 1.53, p < 0.001) were more likely to have an ileostomy rather than permanent colostomy. In those with ileostomy, RAS was associated with fewer ileus (OR 0.71, p < 0.001) and less bleeding (OR 0.50, p < 0.001) compared to Lap. In addition, RAS was associated with lower anastomotic leak (OR 0.25, p < 0.001), less bleeding (OR 0.51, p < 0.001), and fewer blood transfusions (OR 0.70, p = 0.022) when compared to OS. In those patients who had permanent colostomy formation, RAS was associated with fewer ileus (OR 0.72, p < 0.001), less bleeding (OR 0.78, p = 0.021), lower 30-day reoperation (OR 0.49, p < 0.001), and higher discharge to home (OR 1.26, p = 0.013) than Lap, as well as OS.
CONCLUSIONS: Rectal cancer patients treated with RAS were more likely to have an ileostomy rather than a permanent colostomy and more enhanced recovery compared to Lap and OS.
METHODS: We identified all patients aged ≥ 18 years who had elective rectal cancer resection requiring temporary or permanent stoma formation from 1/2013 to 12/2020 from the PINC AI™ Healthcare Database. We completed multivariable logistic regression analysis accounting for hospital clustering to compare ileostomy formation between surgical approaches. Next, we built inverse probability of treatment-weighted analyses to compare outcomes for ileostomy and permanent colostomy separately. Outcomes included postoperative complications, in-hospital mortality, discharge to home, reoperation, and 30-day readmission.
RESULTS: A total of 12,787 patients (OS: 5599 [43.8%]; Lap: 2872 [22.5%]; RAS: 4316 [33.7%]) underwent elective rectal cancer resection. Compared to OS, patients who had Lap (OR 1.29, p < 0.001) or RAS (OR 1.53, p < 0.001) were more likely to have an ileostomy rather than permanent colostomy. In those with ileostomy, RAS was associated with fewer ileus (OR 0.71, p < 0.001) and less bleeding (OR 0.50, p < 0.001) compared to Lap. In addition, RAS was associated with lower anastomotic leak (OR 0.25, p < 0.001), less bleeding (OR 0.51, p < 0.001), and fewer blood transfusions (OR 0.70, p = 0.022) when compared to OS. In those patients who had permanent colostomy formation, RAS was associated with fewer ileus (OR 0.72, p < 0.001), less bleeding (OR 0.78, p = 0.021), lower 30-day reoperation (OR 0.49, p < 0.001), and higher discharge to home (OR 1.26, p = 0.013) than Lap, as well as OS.
CONCLUSIONS: Rectal cancer patients treated with RAS were more likely to have an ileostomy rather than a permanent colostomy and more enhanced recovery compared to Lap and OS.
摘要：
背景：尽管在直肠癌切除术中广泛采用了机器人辅助手术（RAS），与腹腔镜（Lap）和开放（OS）手术相比，其临床优势仍然有限。我们旨在比较RAS与Lap和OS治疗直肠癌的临床结果。
方法：我们从PINCAI™Healthcare数据库中确定了所有年龄≥18岁的患者，这些患者在2013年1月至2020年12月接受了需要暂时性或永久性造口形成的选择性直肠癌切除术。我们完成了考虑医院聚类的多变量逻辑回归分析，以比较手术方法之间的回肠造口术形成。接下来,我们建立了治疗加权反概率分析,以分别比较回肠造口术和永久性结肠造口术的结局.结果包括术后并发症，住院死亡率，出院回家，再操作,30天的重新接纳。
结果：共有12,787例患者（OS：5599[43.8%]；Lap：2872[22.5%]；RAS：4316[33.7%]）接受了择期直肠癌切除术。与OS相比，有Lap(OR1.29,p<0.001)或RAS(OR1.53,p<0.001)的患者更有可能进行回肠造口术,而不是永久性结肠造口术.在那些有回肠造口术的人中，与Lap相比，RAS与较少的肠梗阻（OR0.71，p<0.001）和较少的出血（OR0.50，p<0.001）相关。此外,RAS与较低的吻合口漏相关（OR0.25，p<0.001），出血减少（OR0.51，p<0.001），与OS相比，输血次数较少（OR0.70，p=0.022）。在那些有永久性结肠造口形成的患者中，RAS与较少的肠梗阻相关(OR0.72,p<0.001),出血减少（OR0.78，p=0.021），30天再次手术减少（OR0.49，p<0.001），和更高的放电回家（OR1.26，p=0.013）比Lap，以及OS。
结论：与Lap和OS相比，接受RAS治疗的直肠癌患者更有可能进行回肠造口术而不是永久性结肠造口术，并且恢复更快。
方法：我们从PINCAI™Healthcare数据库中确定了所有年龄≥18岁的患者，这些患者在2013年1月至2020年12月接受了需要暂时性或永久性造口形成的选择性直肠癌切除术。我们完成了考虑医院聚类的多变量逻辑回归分析，以比较手术方法之间的回肠造口术形成。接下来,我们建立了治疗加权反概率分析,以分别比较回肠造口术和永久性结肠造口术的结局.结果包括术后并发症，住院死亡率，出院回家，再操作,30天的重新接纳。
结果：共有12,787例患者（OS：5599[43.8%]；Lap：2872[22.5%]；RAS：4316[33.7%]）接受了择期直肠癌切除术。与OS相比，有Lap(OR1.29,p<0.001)或RAS(OR1.53,p<0.001)的患者更有可能进行回肠造口术,而不是永久性结肠造口术.在那些有回肠造口术的人中，与Lap相比，RAS与较少的肠梗阻（OR0.71，p<0.001）和较少的出血（OR0.50，p<0.001）相关。此外,RAS与较低的吻合口漏相关（OR0.25，p<0.001），出血减少（OR0.51，p<0.001），与OS相比，输血次数较少（OR0.70，p=0.022）。在那些有永久性结肠造口形成的患者中，RAS与较少的肠梗阻相关(OR0.72,p<0.001),出血减少（OR0.78，p=0.021），30天再次手术减少（OR0.49，p<0.001），和更高的放电回家（OR1.26，p=0.013）比Lap，以及OS。
结论：与Lap和OS相比，接受RAS治疗的直肠癌患者更有可能进行回肠造口术而不是永久性结肠造口术，并且恢复更快。
