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机器人肿瘤特异性直肠系膜切除术治疗直肠癌的多中心研究。

Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer.

机构信息

Division of General and Oncologic Surgery, City of Hope National Medical Center, Duarte, CA, USA.

出版信息

Ann Surg Oncol. 2010 Jun;17(6):1614-20. doi: 10.1245/s10434-010-0909-3. Epub 2010 Jan 20.

Abstract

BACKGROUND

Recently, traditional laparoscopic anterior resection has been used for rectal cancer, offering good functional results compared with open resection and resulting in better early postoperative outcomes. Few studies investigating the role of robot-assisted tumor-specific rectal surgery (RTSRS) have been carried out to show its feasibility. The aim of the study was to verify on a multicentric basis the perioperative and oncologic outcome of RTSRS.

METHODS

One hundred forty-three consecutive patients undergoing RTSR in three centers were reviewed. Pathologic data, and postoperative and oncologic outcome measures were prospectively collected and analyzed by an independent researcher.

RESULTS

A total of 112 restorative surgeries and 31 abdominoperineal resections were carried out. Conversion rate was 4.9%, mean blood loss was 283 ml, and mean operative time was 297 min. The number of harvested nodes (14.1 +/- 6.5) and margin status compared favorably with those of open series (mean distal margin 2.9 +/- 1.8 cm; negative radial margin in 142 cases). The 3-year overall survival rate was 97%, and no isolated local recurrences were found at mean follow-up of 17.4 months.

CONCLUSION

RTSRS is a safe and feasible procedure that may facilitate mesorectal excision. Randomized clinical trials and longer follow-up are needed to evaluate a possible influence of RTSRS on patient survival.

摘要

背景

最近,传统的腹腔镜前切除术已被用于直肠癌,与开放性切除术相比,它具有良好的功能结果,并导致更好的术后早期结果。很少有研究探讨机器人辅助肿瘤特异性直肠手术(RTSRS)的作用,以显示其可行性。本研究的目的是在多中心基础上验证 RTSRS 的围手术期和肿瘤学结果。

方法

回顾了三个中心的 143 例连续接受 RTSRS 的患者。由独立研究员前瞻性收集和分析病理数据以及术后和肿瘤学结果指标。

结果

共进行了 112 例保肛手术和 31 例腹会阴切除术。转换率为 4.9%,平均失血量为 283ml,平均手术时间为 297 分钟。采集的淋巴结数量(14.1±6.5)和边缘状态与开放性系列相比具有优势(平均远端边缘 2.9±1.8cm;142 例为阴性放射状边缘)。3 年总生存率为 97%,在平均 17.4 个月的随访中未发现孤立的局部复发。

结论

RTSRS 是一种安全可行的手术方法,可能有助于中直肠切除术。需要进行随机临床试验和更长时间的随访,以评估 RTSRS 对患者生存的可能影响。

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