Department of Colorectal Surgery, Poole Hospital NHS Foundation Trust, Poole, UK.
Department of Colorectal Surgery, Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, UK.
Colorectal Dis. 2017 Dec;19(12):1092-1099. doi: 10.1111/codi.13783.
Laparoscopic rectal surgery is associated with a steep learning curve and high conversion rate despite progress in equipment design and consistent practice. The robotic system has shown an advantage over the laparoscopic approach due to stable three-dimensional views, improved dexterity and better ergonomics. These factors make the robotic approach more favourable for rectal surgery. The aim of this study was to compare the perioperative outcomes of laparoscopic and robotic rectal cancer surgery in high-risk patients.
A prospectively collected dataset for high-risk patients who underwent rectal cancer surgery between May 2013 and November 2015 was analysed. Patients with any of the following characteristics were defined as high risk: a body mass index ≥30, male gender, preoperative chemoradiotherapy, tumour <8 cm from the anal verge and previous abdominal surgery.
In total, 184 high-risk patients were identified: 99 in the robotic group and 85 in the laparoscopic group. Robotic surgery was associated with a significantly higher sphincter preservation rate (86% vs 74%, P = 0.045), shorter operative time (240 vs 270 min, P = 0.013) and hospital stay (7 vs 9 days, P = 0.001), less blood loss (10 vs 100 ml, P < 0.001) and a smaller conversion rate to open surgery (0% vs 5%, P = 0.043) compared with the laparoscopic technique. Reoperation, anastomotic leak rate, 30-day mortality and oncological outcomes were comparable between the two techniques.
Robotic surgery in high-risk patients is associated with higher sphincter preservation, reduced blood loss, smaller conversion rates, and shorter operating time and hospital stay. However, further studies are required to evaluate this notion.
尽管设备设计不断进步和实践经验不断积累，腹腔镜直肠手术仍存在陡峭的学习曲线和较高的中转开腹率。机器人系统由于提供稳定的三维视野、改善的灵巧性和更好的人体工程学而显示出优于腹腔镜的优势。这些因素使得机器人方法更有利于直肠手术。本研究旨在比较高危患者腹腔镜和机器人直肠肿瘤手术的围手术期结果。
对 2013 年 5 月至 2015 年 11 月间接受直肠肿瘤手术的高危患者的前瞻性收集数据集进行了分析。具有以下特征之一的患者被定义为高危：体质量指数≥30、男性、术前放化疗、肿瘤距肛缘<8cm 和既往腹部手术。
共确定了 184 名高危患者：机器人组 99 例，腹腔镜组 85 例。机器人手术与更高的肛门保留率（86%比 74%，P=0.045）、更短的手术时间（240 分钟比 270 分钟，P=0.013）和住院时间（7 天比 9 天，P=0.001）、更少的出血量（10 毫升比 100 毫升，P<0.001）和较低的中转开腹率（0%比 5%，P=0.043）相关。两种技术之间的再次手术、吻合口漏率、30 天死亡率和肿瘤学结果相当。
在高危患者中，机器人手术与更高的肛门保留率、减少出血量、较低的中转开腹率以及更短的手术时间和住院时间相关。然而，需要进一步的研究来评估这一观点。
