与腹腔镜切除术相比，机器人切除术是直肠癌的一个良好预后因素：使用倾向评分匹配的长期生存分析

Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching.

作者信息

Kim Jin, Baek Se-Jin, Kang Dong-Woo, Roh Young-Eun, Lee Jae Won, Kwak Han-Deok, Kwak Jung Myun, Kim Seon-Hahn

机构信息

1Department of Surgery, Korea University College of Medicine, Seoul, Korea 2Department of Statistics, Korea University College of Political Science and Economics, Seoul, Korea.

出版信息

Dis Colon Rectum. 2017 Mar;60(3):266-273. doi: 10.1097/DCR.0000000000000770.

DOI:10.1097/DCR.0000000000000770

PMID:28177988

Abstract

BACKGROUND

Robotic total mesorectal excision for rectal cancer has rapidly increased and has shown short-term outcomes comparable to conventional laparoscopic total mesorectal excision. However, data for long-term oncologic outcomes are limited.

OBJECTIVE

The aim of this study is to evaluate long-term oncologic outcomes of robotic total mesorectal excision compared with laparoscopic total mesorectal excision.

DESIGN

This was a retrospective study.

SETTINGS

This study was conducted in a tertiary referral hospital.

PATIENTS

A total of 732 patients who underwent totally robotic (n = 272) and laparoscopic (n = 460) total mesorectal excision for rectal cancer were included in this study.

MAIN OUTCOME MEASURES

We compared clinicopathologic outcomes of patients. In addition, short- and long-term outcomes and prognostic factors for survival were evaluated in the matched robotic and laparoscopic total mesorectal excision groups (224 matched pairs by propensity score).

RESULTS

Before case matching, patients in the robotic group were younger, more likely to have undergone preoperative chemoradiation, and had a lower tumor location than those in the laparoscopic group. After case matching most clinicopathologic outcomes were similar between the groups, but operative time was longer and postoperative ileus was more frequent in the robotic group. In the matched patients excluding stage IV, the overall survival, cancer-specific survival, and disease-free survival were better in the robotic group, but did not reach statistical significance. The 5-year survival rates for robotic and laparoscopic total mesorectal excision were 90.5% and 78.0% for overall survival, 90.5% and 79.5% for cancer-specific survival, and 72.6% and 68.0% for disease-free survival. In multivariate analysis, robotic surgery was a significant prognostic factor for overall survival and cancer-specific survival (p = 0.0040, HR = 0.333; p = 0.0161, HR = 0.367).

LIMITATIONS

This study has the potential for selection bias and limited generalizability.

CONCLUSIONS

Robotic total mesorectal excision for rectal cancer showed long-term survival comparable to laparoscopic total mesorectal excision in this study. Robotic surgery was a good prognostic factor for overall survival and cancer-specific survival, suggesting potential oncologic benefits.

摘要

背景

直肠癌的机器人全直肠系膜切除术应用迅速增加，且短期疗效与传统腹腔镜全直肠系膜切除术相当。然而，长期肿瘤学结局的数据有限。

目的

本研究旨在评估机器人全直肠系膜切除术与腹腔镜全直肠系膜切除术相比的长期肿瘤学结局。

设计

这是一项回顾性研究。

地点

本研究在一家三级转诊医院进行。

患者

本研究纳入了732例行机器人全直肠系膜切除术（n = 272）和腹腔镜全直肠系膜切除术（n = 460）的直肠癌患者。

主要观察指标

我们比较了患者的临床病理结局。此外，还评估了配对的机器人和腹腔镜全直肠系膜切除术组（倾向评分匹配224对）的短期和长期结局及生存预后因素。

结果

病例匹配前，机器人组患者比腹腔镜组患者更年轻，更可能接受过术前放化疗，且肿瘤位置更低。病例匹配后，两组间大多数临床病理结局相似，但机器人组手术时间更长，术后肠梗阻更常见。在排除IV期的匹配患者中，机器人组的总生存、癌症特异性生存和无病生存情况更好，但未达到统计学显著性。机器人和腹腔镜全直肠系膜切除术的5年总生存率分别为90.5%和78.0%，癌症特异性生存率分别为90.5%和79.5%，无病生存率分别为72.6%和68.0%。多因素分析中，机器人手术是总生存和癌症特异性生存的显著预后因素（p = 0.0040，HR = 0.333；p = 0.0161，HR = 0.367）。