Moghadamyeghaneh Zhobin, Hanna Mark H, Carmichael Joseph C, Pigazzi Alessio, Stamos Michael J, Mills Steven
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.
Surg Endosc. 2016 Jul;30(7):2792-8. doi: 10.1007/s00464-015-4552-8. Epub 2015 Oct 20.
The utilization of minimally invasive surgery is increasing in colorectal surgery. We sought to compare the outcomes of patients who underwent elective open, laparoscopic, and robotic total abdominal colectomy.
The NIS database was used to examine the clinical data of patients who underwent an elective total colectomy procedure during 2009-2012. Multivariate regression analysis was performed to compare the three surgical approaches.
We sampled a total of 26,721 patients who underwent elective total colectomy. Of these, 16,780 (62.8 %) had an open operation, while 9934 (37.2 %) had a minimally invasive approach (9614 laparoscopic surgery, and 326 robotic surgery). The most common indication for an operation was ulcerative colitis (31 %). Patients who underwent open surgery had significantly higher mortality and morbidity compared to laparoscopic (AOR 2.48, 1.30, P < 0.01) and robotic approaches (AOR 1.04, 1.30, P < 0.01 and P = 0.04, respectively). There was no significant difference in mortality and morbidity between the laparoscopic and robotic approaches (AOR 0.96, 1.03, P = 0.10, P = 0.78). However, conversion rate of laparoscopic surgery to open was significantly higher than that of robotic approach (13.3 vs. 1.5 %, P < 0.01). Patients who underwent laparoscopic surgery had significantly lower total hospital charges compared to patients who underwent open surgery (mean difference = $21,489, P < 0.01). Also, total hospital charges for a robotic approach were significantly higher than for a laparoscopic approach (mean difference = $15,595, P < 0.01).
Minimally invasive approaches to total colectomy are safe, with the advantage of lower mortality and morbidity compared to an open approach. Although there was no significant difference in the morbidity between minimally invasive approaches, robotic surgery had a significantly lower conversion rate compared to laparoscopic approach. Total hospital charges are significantly higher in robotic surgery compared to laparoscopic approach.
在结直肠手术中，微创手术的应用正在增加。我们试图比较接受择期开放性、腹腔镜和机器人辅助全腹结肠切除术患者的手术结果。
利用国家住院患者样本（NIS）数据库检查2009年至2012年期间接受择期全结肠切除术患者的临床数据。进行多因素回归分析以比较三种手术方式。
我们共抽取了26721例接受择期全结肠切除术的患者。其中，16780例（62.8%）接受了开放手术，而9934例（37.2%）采用了微创方法（9614例腹腔镜手术和326例机器人手术）。最常见的手术指征是溃疡性结肠炎（31%）。与腹腔镜手术（调整后比值比[AOR]为2.48、1.30，P<0.01）和机器人辅助手术（AOR分别为1.04、1.30，P<0.01和P=0.04）相比，接受开放手术的患者死亡率和发病率显著更高。腹腔镜手术和机器人辅助手术在死亡率和发病率方面无显著差异（AOR为0.96、1.03，P=0.10、P=0.78）。然而，腹腔镜手术转为开放手术的转化率显著高于机器人辅助手术（13.3%对1.5%，P<0.01）。与接受开放手术的患者相比，接受腹腔镜手术的患者总住院费用显著更低（平均差值=$21489，P<0.01）。此外，机器人辅助手术的总住院费用显著高于腹腔镜手术（平均差值=$15595，P<0.01）。
全结肠切除术的微创方法是安全的，与开放手术相比具有更低的死亡率和发病率。尽管微创方法之间的发病率无显著差异，但机器人手术的转化率显著低于腹腔镜手术。机器人手术的总住院费用显著高于腹腔镜手术。
