Langer D, Tučková I, Kalvach J, Ryska M
Rozhl Chir. 2017 Winter;96(2):69-74.
The introduction of total mesorectal excision (TME) in the 1980s was pivotal in the surgical treatment for rectal carcinoma (RC). Routinely applied TME led to a significant reduction in the incidence of local recurrences. The purpose of our paper is to present the results of our non-randomized study comparing prospectively acquired data from radical resection / rectal extirpation using classic open access, laparoscopy and da Vinci robotic system.
The study group included 116 patients with RC who underwent radical surgical treatment between 1/2014-12/2016, after which the collected resection specimens were assessed in pathology laboratories of the referring hospital using the Quirkes protocol. Analysis of data collected prospectively over a period of 3 years was done. The surgical procedures were open, laparoscopic and robotic. Robotic surgery could only be performed in patients whose health insurers guaranteed to cover the robotic resection expenses. Those patients whose health insurers did not cover the costs of the robotic assisted procedure were treated using the laparoscopic technique.
Over a period of 3 years (2014-2016), the teams at the Department of Surgery of the 2nd Faculty of Medicine, Charles University and Central Military Hospital, Prague treated 116 patients (75 men and 41 women) for RC; resected specimens of the patients were processed according to the Quirkes protocol. Mean age was 63 years (33-80). pCRO positivity was confirmed in 5 patients (4.3%) and complete or nearly complete TME was achieved in 94 patients (81%). More than a half of the procedures were performed using the minimally invasive surgery. No patient died.
Despite the high rate of technically difficult cases (male sex, tumours in the distal third of the rectum), the robotic assisted treatment showed best results in our study group in terms of quality of the mesorectal excision. Our results thus provide evidence of an unequivocal benefit of robotic assistance compared to manual laparoscopy and open procedures in terms of TME as a quality indicator of surgery in patients with CR. Given the limited time span, there are no long-term results to be assessed in our patients.Key words: rectal carcinoma - TME - evaluation of surgical treatment - robotic rectal surgery.
20世纪80年代全直肠系膜切除术（TME）的引入是直肠癌（RC）外科治疗的关键。常规应用TME导致局部复发率显著降低。本文的目的是展示我们的非随机研究结果，该研究前瞻性地比较了使用经典开放手术、腹腔镜手术和达芬奇机器人系统进行根治性切除/直肠切除所获得的数据。
研究组包括116例RC患者，他们在2014年1月至2016年12月期间接受了根治性手术治疗，术后将收集的切除标本在转诊医院的病理实验室按照Quirkes方案进行评估。对前瞻性收集的3年数据进行了分析。手术方式包括开放手术、腹腔镜手术和机器人手术。机器人手术仅能在其健康保险公司保证支付机器人切除费用的患者中进行。那些健康保险公司不承担机器人辅助手术费用的患者采用腹腔镜技术治疗。
在3年（2014 - 2016年）期间，布拉格查理大学第二医学院外科和中央军事医院的团队对116例RC患者（75例男性和41例女性）进行了治疗；患者的切除标本按照Quirkes方案进行处理。平均年龄为63岁（33 - 80岁）。5例患者（4.3%）pCRO呈阳性，94例患者（81%）实现了完全或近乎完全的TME。超过一半的手术采用了微创手术。无患者死亡。
尽管技术难度高的病例比例较大（男性、直肠远端三分之一的肿瘤），但在我们的研究组中，机器人辅助治疗在直肠系膜切除质量方面显示出最佳效果。因此，我们的结果提供了证据，表明在以TME作为CR患者手术质量指标方面，与手动腹腔镜手术和开放手术相比，机器人辅助具有明确的益处。鉴于时间跨度有限，我们的患者尚无长期结果可供评估。关键词：直肠癌 - TME - 手术治疗评估 - 机器人直肠手术
