Colombo Pierre-Emmanuel, Bertrand Martin M, Alline Mathias, Boulay Eric, Mourregot Anne, Carrère Sébastien, Quénet François, Jarlier Marta, Rouanet Philippe
Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
Biometrics Unit, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
Ann Surg Oncol. 2016 May;23(5):1594-600. doi: 10.1245/s10434-015-5048-4. Epub 2015 Dec 29.
Robotic total mesorectal excision (R-TME), a novel way for minimally invasive treatment of rectal cancer, was shown in previous studies to be safe and effective. However, comparison with laparoscopic total mesorectal excision (L-TME) has drawn contradictory disputes, especially concerning operative high-risk patients. The aim of this study was to compare R-TME and L-TME on the rectal technical approach.
Between October 2009 and March 2013, a total of 120 consecutive rectal carcinomas, operated for sphincter-saving procedure, were enrolled. The patient population included the last 60 laparoscopic procedures and the first 60 robotic surgeries (six hybrid approaches, then 54 full robotic surgeries). There were no exclusions.
Patients' baseline characteristics were similar in both the R-TME and L-TME groups. Outcomes were equivalent for blood loss (200 vs. 100 mL), postoperative hospital stay (12 vs. 11 days), conversion rate (3.2 vs. 4.8 %), lymph nodes yield (15 vs. 19), no positive distal margin (0 %), positive radial margin (6.4 vs. 9.3 %), diverting ileostomy (73 vs. 58 %) and severe morbidity (28 vs. 20 %). Significant differences were found for median operative time (274 vs. 228 min; p = 0.003) and proctectomy performed via transanal approach (1.7 vs. 16.7 %; p = 0.004). The R-TME operative time curve stabilized to 245 min after the first 25 procedures.
For rectal cancer, R-TME may be as feasible and safe as L-TME in terms of technique. In our practice and for difficult cases, R-TME allows complete rectal dissection by an abdominal approach, while L-TME requires a transanal approach.
机器人全直肠系膜切除术（R-TME）是一种用于直肠癌微创治疗的新方法，先前研究表明其安全有效。然而，与腹腔镜全直肠系膜切除术（L-TME）的比较引发了相互矛盾的争议，尤其是在手术高危患者方面。本研究旨在比较R-TME和L-TME在直肠手术技术方法上的差异。
2009年10月至2013年3月期间，共纳入120例连续接受保肛手术的直肠癌患者。患者群体包括最后60例腹腔镜手术和最初60例机器人手术（6例混合手术，然后是54例全机器人手术）。无排除标准。
R-TME组和L-TME组患者的基线特征相似。两组在失血量（200 vs. 100 mL）、术后住院时间（12 vs. 11天）、中转率（3.2 vs. 4.8%）、淋巴结获取数量（15 vs. 19）、远端切缘阴性率（0%）、环周切缘阳性率（6.4 vs. 9.3%）、造口率（73 vs. 58%）和严重并发症发生率（28 vs. 20%）方面相当。在中位手术时间（274 vs. 228分钟；p = 0.003）和经肛门途径进行的直肠切除术方面存在显著差异（1.7 vs. 16.7%；p = 0.004）。在前25例手术后，R-TME手术时间曲线稳定在245分钟。
对于直肠癌，R-TME在技术方面可能与L-TME一样可行和安全。在我们的实践中以及对于困难病例，R-TME可通过腹部途径完成直肠完全游离，而L-TME则需要经肛门途径。
