Zhang Hairong, Yuan Weitang, Zhou Quanbo, Gu Xiaoming, Wang Fuqi
Department of Colonrectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 May 25;20(5):540-544.
To compare the clinical efficacy of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancers.
From January 2015 to March 2016, intra-operative and postoperative follow-up data of 30 patients with middle-low rectal cancers who underwent robotic radical resection(robot group) and 32 patients with middle-low rectal cancers who underwent laparoscopic radical resection (laparoscopy group)n in our department were retrospectively collected. The distance from cancer to anal margin was less than 10 cm in both two groups and advanced rectal cancers were confirmed by preoperative colonoscopy biopsy. Associated data were compared between two groups.
There were 13 males and 17 females in robot group with age of 27 to 85 (mean 59.7) years, disease course of 3 to 12 (mean 6.2) months and clinical stage T2-3N0-1. There were 16 males and 16 females in laparoscopic group with age of 32 to 79 (mean 60.3) years, disease course of 2 to 10(mean 5.9) months and clinical stage T2-3N0-1. The baseline data of two groups were not significantly different (all P>0.05). All the patients in two groups completed operations successfully without conversion to open operation. Compared with laparoscopic group, the blood loss was less [(100.3±43.7) ml vs. (150.3±68.2) ml, t=3.413, P=0.001], the first flatus time [(49.3±12.4) h vs. (58.6±12.5) h, t=2.838, P=0.006] and urinary catheter removal time [(3.0±0.7) d vs. (4.8±0.9) d, t=5.491, P=0.000] were shorter, while the operation time [(217.3±57.8) min vs. (187.9±23.1) min, t=2.772, P=0.009] was longer in robot group. No cancer tissue was observed in resection margin of two groups. Number of harvested lymph node per case (15.2±7.4 vs. 13.9±4.9, t=-0.764, P=0.448), distance from anal margin to tumor distal edge [(7±3) cm vs. (6.5±3) cm, t=-1.952, P=0.056] and postoperative hospital stay [(13.6±1.3) d vs. (13.8±1.8) d, t=0.925, P=0.359] were not significantly different between two groups. No serious complications occurred in two groups during intra-operative and postoperative period. During following up of 3 to 12 (average 8.7) months, 1 case of anastomotic fistula occurred in each group and was cured by conservative treatment without significant difference [3.3%(1/30) vs. 3.1%(1/32), P=1.000]. No sexual dysfunction was found in either groups. Two cases in laparoscopic group presented relapse and metastasis, but no recurrence and metastasis was observed in robot group. There was no death in two groups.
Robotic radical surgery in the treatment of middle-low rectal cancers is safe and effective with the advantages of less trauma, less bleeding, rapid recovery of intestinal function and urinary function.
比较机器人根治性手术与腹腔镜根治性手术治疗中低位直肠癌的临床疗效。
回顾性收集2015年1月至2016年3月在我科接受机器人根治性切除术的30例中低位直肠癌患者（机器人组）和接受腹腔镜根治性切除术的32例中低位直肠癌患者（腹腔镜组）的术中及术后随访资料。两组患者癌灶距肛缘均小于10 cm，术前均经结肠镜活检确诊为进展期直肠癌。比较两组相关数据。
机器人组男13例，女17例，年龄27～85岁（平均59.7岁），病程3～12个月（平均6.2个月），临床分期T2-3N0-1。腹腔镜组男16例，女16例，年龄32～79岁（平均60.3岁），病程2～10个月（平均5.9个月），临床分期T2-3N0-1。两组基线资料差异无统计学意义（均P>0.05）。两组患者均顺利完成手术，无一例中转开腹。与腹腔镜组比较，机器人组术中出血量少[（100.3±43.7）ml比（150.3±68.2）ml，t=3.413，P=0.001]，首次排气时间[（49.3±12.4）h比（58.6±12.5）h，t=2.838，P=0.006]和拔除尿管时间[（3.0±0.7）d比（4.8±0.9）d，t=5.491，P=0.000]短，而手术时间[（217.3±57.8）min比（187.9±23.1）min，t=2.772，P=0.009]长。两组切缘均未见癌组织。两组每例患者的淋巴结清扫数目（15.2±7.4比13.9±4.9，t=-0.764，P=0.448）、肛缘至肿瘤远端边缘距离[（7±3）cm比（6.5±3）cm，t=-1.952，P=0.056]及术后住院时间[（13.6±1.3）d比（13.8±1.8）d，t=0.925，P=0.359]差异无统计学意义。两组术中及术后均未发生严重并发症。随访3～～12个月（平均8.7个月），两组各有1例发生吻合口瘘，均经保守治疗治愈，差异无统计学意义[3.3%（1/30）比3.1%（1/32），P=1.000]。两组均未发现性功能障碍。腹腔镜组有2例出现复发转移，机器人组未观察到复发转移。两组均无死亡病例。
机器人根治性手术治疗中低位直肠癌安全有效，具有创伤小、出血少、肠道功能和泌尿功能恢复快等优点。
