Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Surg Endosc. 2018 Nov;32(11):4498-4505. doi: 10.1007/s00464-018-6197-x. Epub 2018 May 2.
The long-term outcomes of robotic-assisted laparoscopic lateral lymph node dissection (RALLD) have not been fully investigated. This study aimed to assess the oncological and long-term outcomes of RALLD for rectal cancer through comparison with those of open lateral lymph node dissection (OLLD) in a retrospective study.
Between September 2002 and October 2014, the medical data of 426 patients who underwent total mesorectal excision with lateral lymph node dissection for primary rectal cancer were collected. Of these, 115 patients were excluded after data collection (stage IV, n = 61; total pelvic exenteration, n = 31; multiple cancer, n = 20; conventional laparoscopic surgery, n = 3). Before matching, 311 patients with clinical stage II/III were analyzed. Using exact matching, patients were stratified into RALLD (n = 78) and OLLD (n = 78) groups. Pathological findings and long-term outcomes were compared between the groups.
The pathological stage and number of harvested lymph nodes showed no significant differences between the groups. The rate of positive resection margin in the RALLD group tended to be lower compared with that of the OLLD group (p = 0.059). The median follow-up duration was 54.0 months in 156 patients. The 5-year overall survival rate was 95.4 and 87.8% in the RALLD and OLLD groups, respectively (p = 0.106). The 5-year relapse-free survival rate was 79.1 and 69.9% in the RALLD and OLLD groups, respectively (p = 0.157). The 5-year local relapse-free survival rate was 98.6 and 90.9% in the RALLD and OLLD groups, respectively (p = 0.029).
The short- and long-term outcomes indicated that RALLD may be a useful modality for locally advanced low rectal cancer.
机器人辅助腹腔镜侧方淋巴结清扫术（RALLD）的长期结果尚未得到充分研究。本研究旨在通过与开放式侧方淋巴结清扫术（OLLD）的比较，评估 RALLD 治疗直肠癌的肿瘤学和长期结果。
2002 年 9 月至 2014 年 10 月，收集了 426 例接受全直肠系膜切除加侧方淋巴结清扫术治疗原发性直肠癌患者的医疗数据。在数据收集后，排除了 115 例患者（IV 期，n=61；全盆腔切除术，n=31；多种癌症，n=20；常规腹腔镜手术，n=3）。在匹配前，分析了 311 例临床 II/III 期患者。通过精确匹配，将患者分为 RALLD（n=78）和 OLLD（n=78）组。比较两组的病理发现和长期结果。
两组的病理分期和清扫淋巴结数量无显著差异。RALLD 组的阳性切缘率倾向于低于 OLLD 组（p=0.059）。156 例患者的中位随访时间为 54.0 个月。RALLD 组和 OLLD 组的 5 年总生存率分别为 95.4%和 87.8%（p=0.106）。RALLD 组和 OLLD 组的 5 年无复发生存率分别为 79.1%和 69.9%（p=0.157）。RALLD 组和 OLLD 组的 5 年局部无复发生存率分别为 98.6%和 90.9%（p=0.029）。
短期和长期结果表明，RALLD 可能是局部进展期低位直肠癌的一种有用方法。
