Sun Zhifei, Kim Jina, Adam Mohamed A, Nussbaum Daniel P, Speicher Paul J, Mantyh Christopher R, Migaly John
Department of Surgery, Duke University Medical Center, Duke University, Durham, NC.
Ann Surg. 2016 Jun;263(6):1152-8. doi: 10.1097/SLA.0000000000001388.
To examine survival of patients who underwent minimally invasive versus open low anterior resection (LAR) for rectal cancer.
Utilization of laparoscopic and robotic LAR for rectal cancer has steadily increased. Short-term outcomes between these techniques and open surgery have shown equivalent results; however, survival outcomes are unknown.
Adults from the National Cancer Data Base undergoing LAR for rectal adenocarcinoma were identified. Patients were stratified by intent-to-treat into open (OLAR) or minimally invasive LAR (MI-LAR). Multivariable modeling was used to compare short-term outcomes and survival between MI-LAR and OLAR and between laparoscopic (LLAR) and robotic LAR (RLAR).
Among 14,033 patients included, 57.8% underwent OLAR and 42.2% MI-LAR. After adjustment, MI-LAR was associated with shorter length of stay (P < 0.001), but similar rates of positive margins, 30-day readmission, 30-day mortality, and use of adjuvant therapies (all P > 0.05). At 36 months, there was no difference in adjusted risk of mortality between MI-LAR and OLAR (hazard ratio [HR] 0.88, P = 0.089). In a subgroup analysis of LLAR versus RLAR, there were no differences in lymph node harvest, margin positivity, length of stay, readmission rate, 30-day mortality, or overall survival after adjustment (all P > 0.05).
Minimally invasive LAR for rectal cancer is associated with similar overall survival with the benefit of shorter hospitalization. Although the conversion rate is lower, robotic LAR is not associated with superior oncologic outcomes compared to laparoscopic LAR. Our findings support the ongoing adoption of minimally invasive techniques for rectal adenocarcinoma.
研究接受微创与开放低位前切除术（LAR）治疗直肠癌患者的生存率。
腹腔镜和机器人辅助LAR治疗直肠癌的应用稳步增加。这些技术与开放手术的短期结果显示相当；然而，生存结果尚不清楚。
确定美国国家癌症数据库中接受直肠腺癌LAR的成年人。患者按意向性治疗分层为开放手术组（OLAR）或微创LAR组（MI-LAR）。采用多变量模型比较MI-LAR与OLAR以及腹腔镜LAR（LLAR）与机器人辅助LAR（RLAR）之间的短期结果和生存率。
纳入的14033例患者中，57.8%接受OLAR，42.2%接受MI-LAR。调整后，MI-LAR与住院时间缩短相关（P<0.001），但切缘阳性率、30天再入院率、30天死亡率和辅助治疗使用率相似（均P>0.05）。在36个月时，MI-LAR与OLAR之间调整后的死亡风险无差异（风险比[HR]0.88，P=0.089）。在LLAR与RLAR的亚组分析中，调整后淋巴结清扫、切缘阳性、住院时间、再入院率、30天死亡率或总生存率均无差异（均P>0.05）。
直肠癌微创LAR与总体生存率相似，且具有住院时间短的优势。虽然机器人辅助LAR的转换率较低，但与腹腔镜LAR相比，其肿瘤学结局并无优势。我们的研究结果支持持续采用微创技术治疗直肠腺癌。
