■在三级中心比较腹腔镜和机器人全直肠系膜切除术(TME)对直肠癌的长期疗效。
■腹腔镜直肠癌手术具有与开腹手术相当的长期疗效,在短期结果中有几个优势。然而,它有很大的技术限制,机器人方法旨在克服的问题。
■我们纳入了2013年至2021年间接受腹腔镜和机器人TME手术的患者。在倾向评分匹配后比较各组。主要结果是5年总生存率(OS)。次要结果是局部复发(LR),远处复发(DR),无病生存率(DFS),以及短期手术和患者相关结果。
■共纳入594名患者,在倾向评分匹配后,每组仍有215名患者。5年OS存在显着差异(腹腔镜检查为72.4%,机器人为81.7%,P=0.029),但5年期LR没有差异(4.7%对5.2%,P=0.850),DR(16.9%vs13.5%,P=0.390),或DFS(63.9%对74.4%,P=0.086)。机器人组的转化率明显较低(3.7%vs0.5%,P=0.046),住院时间较短[7.0(6.0-13.0)vs6.0(4.0-8.0),P<0.001),术后并发症少(63.5%vs50.7%,P=0.010)。
■这项研究表明,与腹腔镜手术相比,机器人TME手术的5年OS较高与长期肿瘤学结果相当之间存在相关性。此外,较低的转化率,较短的停留时间,术后并发症较少。机器人直肠癌手术是传统方法的安全且有利的替代方法。
UNASSIGNED: To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center.
UNASSIGNED: Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome.
UNASSIGNED: We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes.
UNASSIGNED: A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy vs 81.7% for robotic, P = 0.029), but no difference in 5-year LR (4.7% vs 5.2%, P = 0.850), DR (16.9% vs 13.5%, P = 0.390), or DFS (63.9% vs 74.4%, P = 0.086). The robotic group had significantly less conversion (3.7% vs 0.5%, P = 0.046), shorter length of stay [7.0 (6.0-13.0) vs 6.0 (4.0-8.0), P < 0.001), and less postoperative complications (63.5% vs 50.7%, P = 0.010).
UNASSIGNED: This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.