D'Annibale Annibale, Pernazza Graziano, Morpurgo Emilio, Monsellato Igor, Pende Vito, Lucandri Giorgio, Termini Barbara, Orsini Camillo, Sovernigo Gianna
Minimally Invasive and Robotic Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
Ann Surg Oncol. 2010 Nov;17(11):2856-62. doi: 10.1245/s10434-010-1175-0. Epub 2010 Jun 22.
Colorectal cancer is the fourth leading cause of death in the world. Minimally invasive surgery has been demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. This study aims to evaluate surgical and oncological short-term outcomes of robotic-assisted right colon resection in malignant disease.
Fifty consecutive patients affected by right-sided colon cancer were operated from May 2001 to May 2009 using the da Vinci(®) surgical system. Data regarding surgical and early oncological outcomes were systematically collected in a specific database for statistical analysis.
Twenty-four male and 26 female patients underwent robotic right colectomy. Median age was 73.34 ± 11 years. Median operative time was 223.50 (180-270) min. No conversion occurred. Specimen length was 26.7 ± 8 cm (range 21-50 cm), number of harvested lymph nodes was 18.76 ± 7.2 (range 12-44), and mean number of positive lymph nodes was 1.65 ± 3 (range 0-17). Surgery-related morbidity was 1/50 (2%): one twisting of the mesentery in one case with extracorporeal anastomosis. All patients were included in a follow-up regimen. Disease-free survival was 90% (45/50), and overall survival was 92% (46/50). Cancer-related mortality was 8% (4/50).
Robotic assistance allows performance of oncologically adequate dissection of the right colon with radical lymphadenectomy and to fashion a handsewn intracorporeal anastomosis as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.
结直肠癌是全球第四大致死原因。微创外科手术已被证明与开放手术具有相同的肿瘤学效果，且临床结局更佳。机器人辅助是微创技术的一种发展。本研究旨在评估机器人辅助右半结肠切除术治疗恶性疾病的手术及肿瘤学短期结局。
2001年5月至2009年5月，连续50例右侧结肠癌患者使用达芬奇（®）手术系统进行手术。有关手术和早期肿瘤学结局的数据被系统收集至特定数据库进行统计分析。
24例男性和26例女性患者接受了机器人辅助右半结肠切除术。中位年龄为73.34±11岁。中位手术时间为223.50（180 - 270）分钟。无中转开腹情况。标本长度为26.7±8厘米（范围21 - 50厘米），清扫淋巴结数量为18.76±7.2（范围12 - 44），阳性淋巴结平均数量为1.65±3（范围0 - 17）。手术相关并发症发生率为1/50（2%）：1例体外吻合患者发生肠系膜扭转。所有患者均纳入随访方案。无病生存率为90%（45/50），总生存率为92%（46/50）。癌症相关死亡率为8%（4/50）。
机器人辅助能够进行肿瘤学上充分的右半结肠清扫及根治性淋巴结清扫，并如开放手术一样进行手工体内吻合，证实了该技术的安全性和肿瘤学充分性，结果可接受且短期结局良好。
