Abstract：
OBJECTIVE: Minimally invasive surgery has been increasingly adopted for locally advanced colon cancer. However, evidence comparing robotic (RRC) versus laparoscopic right colectomy (LRC) for nonmetastatic pT4 cancers is lacking.
METHODS: This was a multicentre propensity score-matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra- and postoperative complication rates, overall (OS), and disease-free survival (DFS).
RESULTS: Among a total of 200 patients, 39 RRC were compared with 78 PS-matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1-, 3- and 5-year OS (p = 0.757) and DFS (p = 0.321) did not significantly differ between RRC and LRC.
CONCLUSIONS: Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short-term postoperative outcomes.
METHODS: This was a multicentre propensity score-matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra- and postoperative complication rates, overall (OS), and disease-free survival (DFS).
RESULTS: Among a total of 200 patients, 39 RRC were compared with 78 PS-matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1-, 3- and 5-year OS (p = 0.757) and DFS (p = 0.321) did not significantly differ between RRC and LRC.
CONCLUSIONS: Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short-term postoperative outcomes.
摘要：
目的：微创手术已越来越多地用于局部晚期结肠癌。然而,目前缺乏比较机器人(RRC)和腹腔镜右结肠切除术(LRC)治疗非转移性pT4癌的证据.
方法：这是一项多中心倾向评分匹配（PSM）研究，对接受RRC或LRC治疗的pT4右半结肠癌连续患者进行研究。比较两种手术入路的R0、收集的淋巴结数目,术中和术后并发症发生率，总体(OS)，无病生存率（DFS）。
结果：在总共200名患者中，将39例RRC与78例PS匹配的LRC患者进行了比较。RRC和LRC之间的R0率相似(92.3%与96.2%,分别为；p=0.399)，检索12个或更多淋巴结的几率(97.4%vs.96.2%；p=1）。平均手术时间没有显着差异（192.9分钟与198.3分钟；p=0.750）。然而,RRC与较少的剖腹手术转换相关(5.1%vs.20.5%；p=0.032)，失血少（36.9vs.95.2mL；p<0.0001），术后并发症少（17.9%vs.41%；p=0.013），排气时间较短(2vs.2.8天；p=0.009），住院时间较短(6.4vs.9.5天；p<0.0001)与LRC相比。即使当从分析中排除转化的程序时,也证实了这些结果。1-,3年和5年OS（p=0.757）和DFS（p=0.321）在RRC和LRC之间没有显着差异。
结论：对pT4右半结肠癌进行RRC和LRC观察到足够的肿瘤学结果。然而,RRC与较低的转换率和改善的短期术后结果相关。
方法：这是一项多中心倾向评分匹配（PSM）研究，对接受RRC或LRC治疗的pT4右半结肠癌连续患者进行研究。比较两种手术入路的R0、收集的淋巴结数目,术中和术后并发症发生率，总体(OS)，无病生存率（DFS）。
结果：在总共200名患者中，将39例RRC与78例PS匹配的LRC患者进行了比较。RRC和LRC之间的R0率相似(92.3%与96.2%,分别为；p=0.399)，检索12个或更多淋巴结的几率(97.4%vs.96.2%；p=1）。平均手术时间没有显着差异（192.9分钟与198.3分钟；p=0.750）。然而,RRC与较少的剖腹手术转换相关(5.1%vs.20.5%；p=0.032)，失血少（36.9vs.95.2mL；p<0.0001），术后并发症少（17.9%vs.41%；p=0.013），排气时间较短(2vs.2.8天；p=0.009），住院时间较短(6.4vs.9.5天；p<0.0001)与LRC相比。即使当从分析中排除转化的程序时,也证实了这些结果。1-,3年和5年OS（p=0.757）和DFS（p=0.321）在RRC和LRC之间没有显着差异。
结论：对pT4右半结肠癌进行RRC和LRC观察到足够的肿瘤学结果。然而,RRC与较低的转换率和改善的短期术后结果相关。
