Fantola Giovanni, Brunaud Laurent, Nguyen-Thi Phi-Linh, Germain Adeline, Ayav Ahmet, Bresler Laurent
Department of Digestive, Hepato-Biliary, Endocrine, and Surgical Oncology, CHU Nancy-Hospital Brabois Adultes, University de Lorraine, 11 allee du morvan, 54511, Vandoeuvre les Nancy, France.
Faculty de medicine, INSERM U954, University de Lorraine, Nancy, France.
Updates Surg. 2017 Mar;69(1):45-54. doi: 10.1007/s13304-016-0398-4. Epub 2016 Sep 30.
The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value <38 [OR 1.6; 95 % CI (1.1-2.2)], previous abdominal surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.
世界各地的多个团队都报告了机器人辅助手术在普通外科中的可行性和安全性。由于术后并发症可能导致更长的住院时间和更高的总体费用，分析这类患者术后手术并发症的风险因素具有临床意义。本研究的目的是确定普通外科机器人手术术后发病的风险因素。我们进行了一项单中心观察性回顾性研究。纳入了2001年11月至2013年12月期间所有连续的机器人手术。1000例连续的普通外科患者符合纳入标准。术后总体发病率和主要术后发病率（Clavien>III）的平均发生率分别为20.4%和6%。这包括4.4%的中转率、4.5%的再次手术率和0.2%的死亡率。多因素分析显示，美国麻醉医师协会（ASA）评分>3[比值比（OR）1.7；95%置信区间（CI）（1.2 - 2.4）]、血细胞比容值<38[OR 1.6；95%CI（1.1 - 2.2）]、既往腹部手术史[OR 1.5；95%CI（1 - 2）]、广泛解剖[OR 5.8；95%CI（3.1 - 10.6）]和多象限手术[OR 2.5；95%CI（1.7 - 3.8）]仍然是术后总体发病的独立风险因素。研究还表明，广泛解剖[OR 4.4；95%CI（1.9 - 9.6）]和多象限手术[OR 4.4；95%CI（2.3 - 8.5）]仍然是主要术后发病（Clavien>III）的独立风险因素。本研究确定了普通外科机器人手术术后总体和主要发病的独立风险因素。由于这些因素独立影响术后并发症，我们认为在未来比较普通外科传统腹腔镜手术与机器人辅助腹腔镜手术的研究中可以考虑这些因素。
