Bayraktar Onur, Aytaç Erman, Özben Volkan, Atasoy Deniz, Bilgin İsmail A, Erenler Bayraktar İlknur, Baca Bilgi, Hamzaoğlu İsmail, Karahasanoğlu Tayfun
Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey.
Surg Laparosc Endosc Percutan Tech. 2018 Feb;28(1):e8-e11. doi: 10.1097/SLE.0000000000000500.
Adoption of laparoscopic surgery for cancers requiring partial or total proctectomy has been slow due to difficulty of achieving oncologically adequate resection. Obesity is a factor complicating use and outcomes of laparoscopic technique for rectal surgery. Impact of obesity on the outcomes of robotic rectal surgery for cancer is not well defined. This study is designed to assess whether if the robotic technique has potential to overcome the limitations of obesity and to improve outcomes of minimally invasive rectal surgery for cancer.
Patients undergoing robotic sphincter-saving radical resection with da Vinci Xi System between December 2014 and December 2016 were included. Patients were divided into 2 groups as obese and nonobese. Patient demographics, perioperative outcomes and short-term results were compared between the groups.
The study included 101 patients (30 were obese). Sex (female: 35 vs. 37%, P=0.89), American Society of Anesthesiologists score (2 vs. 2, P=0.41), number of patients undergoing neoadjuvant chemoradiation (39% vs. 23%, P=0.12) and history of prior abdominal surgery (28% vs. 23%, P=0.62) were comparable between the groups. Operative time was longer in the obese group (311 vs. 332 min. P=0.01). Overall complication rates (27% vs. 23%, P=0.72), length of hospital stay (6 vs. 7, P=0.10) and pathologic outcomes were similar between the groups. Conversion to laparoscopy was not required in any operation. Two nonobese patients required conversion to open surgery.
Robotic rectal surgery for cancer in obese patients is equally safe and effective as in nonobese patients. The new robotic platform can facilitate to overcome obesity-related limitations of rectal surgery.
由于难以实现肿瘤学上充分的切除，腹腔镜手术在需要部分或全直肠切除术的癌症治疗中的应用进展缓慢。肥胖是使腹腔镜直肠手术技术的使用和结果复杂化的一个因素。肥胖对机器人直肠癌手术结果的影响尚不明确。本研究旨在评估机器人技术是否有潜力克服肥胖的限制，并改善微创直肠癌手术的结果。
纳入2014年12月至2016年12月期间使用达芬奇Xi系统进行机器人保留括约肌根治性切除术的患者。患者分为肥胖组和非肥胖组。比较两组患者的人口统计学、围手术期结果和短期结果。
该研究纳入了101例患者（30例肥胖）。两组患者的性别（女性：35%对37%，P = 0.89）、美国麻醉医师协会评分（2对2，P = 0.41）、接受新辅助放化疗的患者数量（39%对23%，P = 0.12）以及既往腹部手术史（28%对23%，P = 0.62）具有可比性。肥胖组的手术时间更长（311对332分钟，P = 0.01）。两组的总体并发症发生率（27%对23%，P = 0.72）、住院时间（6对7，P = 0.10）和病理结果相似。所有手术均无需转为腹腔镜手术。两名非肥胖患者需要转为开放手术。
肥胖患者的机器人直肠癌手术与非肥胖患者同样安全有效。新的机器人平台有助于克服直肠手术中与肥胖相关的限制。
