背景:达芬奇机器人辅助手术技术已广泛应用于腹腔镜直肠癌系膜切除术。然而,与传统腹腔镜手术相比,这些手术的短期疗效仍存在争议.目的对比分析达芬奇机器人与腹腔镜手术在直肠癌全系膜切除术(TME)中的近中期疗效,从而为临床实践提供指导和参考。
目的:探讨机器人与腹腔镜全直肠系膜切除术治疗直肠癌的安全性和远期疗效。
方法:回顾性分析2018年8月至2023年3月新疆维吾尔自治区人民医院肛肠科240例直肠癌TME患者的临床病理资料。其中,112例患者行腹腔镜TME(L-TME)组,128例患者接受机器人TME(R-TME)组。术中,术后,比较两组的随访情况。
结果:L-TME组的转化率大于R-TME组(5.4%vs0.8%,χ2=4.417,P=0.036)。L-TME组并发症发生率高于R-TME组(32.1%vs17.2%,χ2=7.290,P=0.007)。L-TME组的环形边缘阳性百分比大于R-TME组(7.1%vs1.6%,χ2=4.658,P=0.031)。L-TME组的3年无病生存率(DFS)和总生存率(OS)均低于R-TME组(74.1%vs85.2%,χ2=4.962,P=0.026;81.3%vs91.4%,χ2=5.494,P=0.019);在美国癌症Ⅲ期联合委员会患者中,L-TME组的DFS率和OS率明显低于R-TME组(52.5%vs76.1%,χ2=5.799,P=0.016;65.0%vs84.8%,χ2=4.787,P=0.029)。
结论:与L-TME组相比,R-TME组肿瘤预后较好,对直肠癌患者更有利,特别是对于III期直肠癌患者。
BACKGROUND: The Da Vinci robot-assisted surgery technique has been widely used in laparoscopic mesangectomy for rectal cancer. However, the short-term efficacy of these procedures compared to traditional laparoscopic surgery remains controversial. The purpose of this study was to compare and analyze the short- and medium-term efficacy of Da Vinci robot and laparoscopic surgery in total mesangectomy (TME) for rectal cancer, so as to provide guidance and reference for clinical practice.
OBJECTIVE: To investigate the safety and long-term efficacy of robotic and laparoscopic total mesorectal resection for the treatment of rectal cancer.
METHODS: The clinicopathologic data of 240 patients who underwent TME for rectal cancer in the Anorectal Department of People\'s Hospital of Xinjiang Uygur Autonomous Region from August 2018 to March 2023 were retrospectively analyzed. Among them, 112 patients underwent laparoscopic TME (L-TME) group, and 128 patients underwent robotic TME (R-TME) group. The intraoperative, postoperative, and follow-up conditions of the two groups were compared.
RESULTS: The conversion rate of the L-TME group was greater than that of the R-TME group (5.4% vs 0.8%, χ 2 = 4.417, P = 0.036). The complication rate of the L-TME group was greater than that of the R-TME group (32.1% vs 17.2%, χ 2 = 7.290, P = 0.007). The percentage of positive annular margins in the L-TME group was greater than that in the R-TME group (7.1% vs 1.6%, χ 2 = 4.658, P = 0.031). The 3-year disease-free survival (DFS) rate and overall survival (OS) rate of the L-TME group were lower than those of the R-TME group (74.1% vs 85.2%, χ 2 = 4.962, P = 0.026; 81.3% vs 91.4%, χ 2 = 5.494, P = 0.019); in patients with American Joint Committee on Cancer stage III DFS rate and OS rate in the L-TME group were significantly lower than those in the R-TME group (52.5% vs 76.1%, χ 2 = 5.799, P = 0.016; 65.0% vs 84.8%, χ 2 = 4.787, P = 0.029).
CONCLUSIONS: Compared with the L-TME group, the R-TME group had a better tumor prognosis and was more favorable for patients with rectal cancer, especially for patients with stage III rectal cancer.