Kim Jin Cheon, Lee Jong Lyul, Alotaibi Abdulrahman Muaod, Yoon Yong Sik, Kim Chan Wook, Park In Ja
Department of Surgery, College of Medicine and Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505, South Korea.
Int J Colorectal Dis. 2017 Aug;32(8):1137-1145. doi: 10.1007/s00384-017-2807-7. Epub 2017 Mar 29.
Few investigations of robot-assisted intersphincteric resection (ISR) are presently available to support this procedure as a safe and efficient procedure. We aimed to evaluate the utility of robot-assisted ISR by comparison between ISR and abdominoperineal resection (APR) using both robot-assisted and open approaches.
The 558 patients with lower rectal cancer (LRC) who underwent curative operation was enrolled between July 2010 and June 2015 to perform either by robot-assisted (ISR vs. APR = 310 vs. 34) or open approaches (144 vs. 70). Perioperative and functional outcomes including urogenital and anorectal dysfunctions were measured. Recurrence and survival were examined in 216 patients in which >3 years had elapsed after the operation.
The robot-assisted approach was the most significant parameter to determine ISR achievement among potent parameters (OR = 3.467, 95% CI = 2.095-5.738, p < 0.001). Early surgical complications occurred more frequently in the open ISR group (16 vs. 7.7%, p = 0.01). The voiding and male sexual dysfunctions were significantly more frequent in the open ISR (p < 0.05). The fecal incontinence and lifestyle alteration score was greater in the open ISR than in the robot-assisted ISR at 12 and 24 months, respectively (p < 0.05). However, the 3-year cumulative rates of local recurrence and survival did not differ between the two groups.
The current procedure of robot-assisted ISR replaced a significant portion of APR to achieve successful SSO via mostly transabdominal approach and double-stapled anastomosis. The robot-assisted ISR with minimal invasiveness might be a help to reduce anorectal and urogenital dysfunctions.
目前很少有关于机器人辅助括约肌间切除术（ISR）的研究能支持该手术是一种安全有效的手术。我们旨在通过比较机器人辅助和开放手术方式下的ISR与腹会阴联合切除术（APR），评估机器人辅助ISR的效用。
纳入2010年7月至2015年6月间接受根治性手术的558例低位直肠癌（LRC）患者，分别采用机器人辅助（ISR与APR = 310例与34例）或开放手术方式（144例与70例）。测量围手术期和功能结局，包括泌尿生殖系统和肛肠功能障碍。对术后3年以上的216例患者进行复发和生存情况检查。
在影响ISR成功的诸多因素中，机器人辅助手术方式是最显著的参数（OR = 3.467，95%CI = 2.095 - 5.738，p < 0.001）。开放ISR组早期手术并发症发生率更高（16%对7.7%，p = 0.01）。开放ISR组排尿和男性性功能障碍明显更常见（p < 0.05）。开放ISR组在12个月和24个月时的大便失禁和生活方式改变评分分别高于机器人辅助ISR组（p < 0.05）。然而，两组的3年局部复发和生存率累积率无差异。
目前的机器人辅助ISR手术通过大多经腹途径和双吻合器吻合，取代了很大一部分APR手术以成功实现超低位前切除术。具有微创性的机器人辅助ISR可能有助于减少肛肠和泌尿生殖系统功能障碍。
