背景:直肠癌是全球癌症相关死亡率的第二大原因,需要手术切除作为唯一的治疗选择。多年来,越来越多地采用微创手术技术,例如机器人和腹腔镜方法。机器人手术代表了一种创新的方式,可以有效地解决与传统腹腔镜技术相关的局限性。虽然先前的研究报道了机器人辅助直肠癌患者根治术的良好围手术期结果,关于其肿瘤安全性的进一步证据仍有必要.
目的:对机器人辅助和腹腔镜辅助低位前切除术(LALAR)的围手术期和肿瘤学结果进行比较分析。
方法:回顾性分析2019年12月至2022年11月在山东第一医科大学附属山东省立医院行机器人辅助低位前切除术(RALAR)125例和LALAR切除术279例患者的临床资料。在执行1:1倾向得分匹配后,将患者分为两组:RALAR组和LALAR组(每组111例)。随后,比较了两组术后30d内的短期结局和3年生存结局.
结果:与LALAR组相比,RALAR组表现出明显更早的时间到第一次肛门排气[2(2-2)dvs3(3-3)d,P=0.000],以及第一次流体饮食的时间较短[4(3-4)dvs5(4-6)d,P=0.001]。此外,RALAR组术后留置尿管时间缩短[2(1-3)dvs4(3-5)d,P=0.000],术后住院时间缩短[5(5-7)dvs7(6-8)d,P=0.009]。此外,与LALAR组相比,RALAR组的住院总费用有观察到的增加[10777(10780-11850)美元vs10550(8766-11715)美元,P=0.012]。两组之间在剖腹手术的转换率或术后并发症的发生率方面没有显着差异。此外,两组间的3年总生存率和3年无病生存率无显著差异.
结论:与LALAR切除术相比,机器人手术在加速胃肠道和泌尿系统功能恢复方面具有潜在优势,同时维持相似的围手术期和3年肿瘤结局。
BACKGROUND: Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide, necessitating surgical resection as the sole treatment option. Over the years, there has been a growing adoption of minimally invasive surgical techniques such as robotic and laparoscopic approaches. Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques. While previous studies have reported favorable perioperative outcomes for robot-assisted radical resection in rectal cancer patients, further evidence regarding its oncological safety is still warranted.
OBJECTIVE: To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection (LALAR) procedures.
METHODS: The clinical data of 125 patients who underwent robot-assisted low anterior resection (RALAR) and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed. After performing a 1:1 propensity score matching, the patients were divided into two groups: The RALAR group and the LALAR group (111 cases in each group). Subsequently, a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.
RESULTS: Compared to the LALAR group, the RALAR group exhibited a significantly earlier time to first flatus [2 (2-2) d vs 3 (3-3) d, P = 0.000], as well as a shorter time to first fluid diet [4 (3-4) d vs 5 (4-6) d, P = 0.001]. Additionally, the RALAR group demonstrated reduced postoperative indwelling catheter time [2 (1-3) d vs 4 (3-5) d, P = 0.000] and decreased length of hospital stay after surgery [5 (5-7) d vs 7(6-8) d, P = 0.009]. Moreover, there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group [10777 (10780-11850) dollars vs 10550 (8766-11715) dollars, P = 0.012]. No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups. Furthermore, no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.
CONCLUSIONS: Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection, while maintaining similar perioperative and 3-year oncological outcomes.