Langer D, Kalvach J, Tučková I, Pudil J, Menclová K, Ryska M
Rozhl Chir. 2015 Dec;94(12):526-30.
The incidence of colorectal cancer (CRC) in the Czech Republic is reported to be one of the highest on the global scale. Radical tumor removal has been observed to be the most effective part in the context of current multimodal therapy. The authors present their preliminary results of robotic assisted treatment of rectal carcinoma (RC).
The observed group includes 61 patients who underwent robotic assisted treatment for rectal cancer. The data were collected prospectively in the last 31 patients. Analyses were conducted on epidemiological data, perioperative outcomes, complications and oncological results.
Robotic assisted treatment of RC was performed in 61 patients: 34 men and 27 women, mean age of 62 years (33-80). Neoadjuvant oncological treatment was indicated in 46% of the patients. Average blood loss was 187 ml, transfusions were administered in three cases. Conversion to open procedure was performed 6 times, and 16 patients had postoperative complications. Anastomotic leak was observed in 10% of the patients, and 4 patients undewent surgical treatment. No patient died. Local recurrence of the cancer was diagnosed in 3 (5%) patients. The quality of mesorectal excision (ME) and the circumferential resection margin [(y)pCRM] have been determined in 27 patients since 2013. Positive (y)pCRM was recorded in two cases and incomplete ME was observed in 25.8% of the patients.
Surgical treatment for RC is pivotal in multimodal therapy. Our preliminary results are similar to the conclusions in other published studies. The da Vinci robotic system is a safe manipulator in the treatment of RC and provides indisputable benefits to the surgeon when operating in the narrow pelvic space. However, the benefits of robotic treatment in abdominal surgery are yet to be evaluated in patients (with respect to long-term results, sufficient number of patients or a high EBM level of evidence). The high purchase price of the robotic device, individual instruments with equipment and non-systemic compensation constitute a significant hindrance that prevents wider use of the robotic system in the treatment of RC and other abdominal malignancies in the Czech Republic.
据报道，捷克共和国的结直肠癌（CRC）发病率在全球范围内位居前列。在当前的多模式治疗中，根治性肿瘤切除被认为是最有效的部分。作者展示了他们机器人辅助治疗直肠癌（RC）的初步结果。
观察组包括61例行机器人辅助直肠癌治疗的患者。对最近31例患者的数据进行前瞻性收集。对流行病学数据、围手术期结果、并发症和肿瘤学结果进行分析。
61例患者接受了机器人辅助直肠癌治疗，其中男性34例，女性27例，平均年龄62岁（33 - 80岁）。46%的患者接受了新辅助肿瘤治疗。平均失血量为187毫升，3例患者接受了输血。6次转为开放手术，16例患者有术后并发症。10%的患者出现吻合口漏，4例患者接受了手术治疗。无患者死亡。3例（5%）患者被诊断为癌症局部复发。自2013年以来，对27例患者进行了直肠系膜切除（ME）质量和环周切缘[（y）pCRM]的评估。2例患者记录为阳性（y）pCRM，25.8%的患者观察到ME不完整。
直肠癌的手术治疗在多模式治疗中至关重要。我们的初步结果与其他已发表研究的结论相似。达芬奇机器人系统在直肠癌治疗中是一种安全的操作设备，在狭窄盆腔空间手术时为外科医生提供了无可争议的优势。然而，机器人治疗在腹部手术中的益处（就长期结果、足够数量的患者或高循证医学证据水平而言）仍有待在患者中评估。机器人设备的高购置价格、单个器械及设备以及非系统性补偿构成了重大障碍，阻碍了机器人系统在捷克共和国直肠癌及其他腹部恶性肿瘤治疗中的更广泛应用。
