Alfieri Sergio, Di Miceli Dario, Menghi Roberta, Cina Caterina, Fiorillo Claudio, Prioli Francesca, Rosa Fausto, Doglietto Giovanni B, Quero Giuseppe
1 Catholic University of Sacred Heart, Rome, Italy.
Surg Innov. 2018 Jun;25(3):258-266. doi: 10.1177/1553350618765868. Epub 2018 Mar 26.
Robotic surgery has gradually gained importance in the treatment of rectal cancer. However, recent studies have not shown any advantages when compared with laparoscopy. The objective of this study is to report a single surgeon's experience in robotic rectal surgery focusing on short-term and long-term outcomes.
Sixty consecutive robotic rectal resections for adenocarcinoma, over a 4-year period, were retrospectively reviewed. Patients' characteristics and perioperative outcomes were analyzed. Oncological outcomes and surgical resection quality as well as overall and disease-free survival were also assessed.
Thirty patients out of 60 (50%) underwent neoadjuvant therapy. Anterior rectal resection was performed in 52 cases (86.7%), and abdominoperineal resection was done in 8 cases (13.3%). Mean operative time was 283 (±68.6) minutes. The conversion rate was 5% (3 patients). Postoperative complications occurred in 10 cases (16.7%), and reoperation was required in 1 case (1.7%). Mean hospital stay was 9 days, while 30-day mortality was 1.7% (1 patients). The histopathological analysis reported a negative circumferential radial margin and distal margins in 100% of cases with a complete or near complete total mesorectal excision in 98.3% of patients. Mean follow-up was 32.8 months with a recurrence rate of 3.4% (2 patients). Overall survival and disease-free survival were 94% and 87%, respectively.
Robotic surgery for rectal cancer proves to be safe and feasible when performed by highly skilled surgeons. It offers acceptable perioperative outcomes with a conversion rate notably lower than with the laparoscopic approach. Adequate pathological results and long-term oncological outcomes were also obtained.
机器人手术在直肠癌治疗中逐渐变得重要。然而，近期研究表明与腹腔镜手术相比并无任何优势。本研究的目的是报告一位外科医生在机器人直肠癌手术方面的经验，重点关注短期和长期结果。
回顾性分析了在4年期间连续进行的60例机器人辅助直肠癌腺癌切除术。分析了患者的特征和围手术期结果。还评估了肿瘤学结果、手术切除质量以及总生存率和无病生存率。
60例患者中有30例（50%）接受了新辅助治疗。52例（86.7%）进行了直肠前切除术，8例（13.3%）进行了腹会阴联合切除术。平均手术时间为283（±68.6）分钟。中转率为5%（3例患者）。10例（16.7%）发生术后并发症，1例（1.7%）需要再次手术。平均住院时间为9天，30天死亡率为1.7%（1例患者）。组织病理学分析显示，100%的病例切缘阴性，98.3%的患者实现了完整或接近完整的直肠系膜全切除。平均随访32.8个月，复发率为3.4%（2例患者）。总生存率和无病生存率分别为94%和87%。
由高技能外科医生进行的机器人直肠癌手术被证明是安全可行的。它提供了可接受的围手术期结果，中转率明显低于腹腔镜手术方法。还获得了充分的病理结果和长期肿瘤学结果。
