Department of Surgery, Amphia Breda, Breda, The Netherlands.
Consulting Biostatistician, Amphia Academy, Amphia Breda, Breda, The Netherlands.
Surg Endosc. 2018 Nov;32(11):4562-4570. doi: 10.1007/s00464-018-6209-x. Epub 2018 May 14.
The role of robotic assistance in colorectal cancer surgery has not been established yet. We compared the results of robotic assisted with those of laparoscopic rectal resections done by two surgeons experienced in laparoscopic as well as in robotic rectal cancer surgery.
Two surgeons who were already experienced laparoscopic colorectal surgeons in 2005 started robotic surgery with the daVinci SI system in 2012. All their rectal cancer resections between 2005 and 2015 were retrieved from a prospectively recorded colorectal database of routinely collected patient data. Multi-organ resections were excluded. Patient data, diagnostic data, data on preceding operations and neoadjuvant treatment, perioperative and operative data, logistic data, and short-term outcomes were gathered. Multivariable analyses (multiple linear and logistic regression) were used to assess differences in several outcomes between the two resection methods while adjusting for all potential confounders we could identify. Results are presented as adjusted mean differences for continuous outcome variables or as adjusted odds ratios (OR) for dichotomous outcome variables.
Three hundred and fifty-two patients with rectal cancers were identified: 168 robotic and 184 conventional laparoscopic cases, 178 operated by surgeon A and 174 operated by surgeon B. Adjusted mean operation time was 215 min in the robotic group which was 40 min (95% CI 24-56; p < 0.0005) longer than the 175 min in the laparoscopic group. Robotic treatment had significantly lesser numbers of conversions (OR 0.09 (0.03-0.32); p < 0.0005) and other complications (SSI and anastomic leakage excluded) (OR 0.32 (0.15-0.69); p = 0.004), adjusted for potential confounders.
Our study suggests that robotic surgery in the hands of experienced laparoscopic rectal cancer surgeons improves the conversion rate and complication rate drastically compared to conventional laparoscopic surgery, but operation time is longer.
机器人辅助在结直肠癌手术中的作用尚未确定。我们比较了两位经验丰富的腹腔镜和机器人结直肠癌手术医生进行的机器人辅助和腹腔镜直肠切除术的结果。
两位在 2005 年已经是腹腔镜结直肠外科医生的外科医生于 2012 年开始使用达芬奇 SI 系统进行机器人手术。他们在 2005 年至 2015 年间所有的直肠癌切除术都从常规收集患者数据的前瞻性记录的结直肠数据库中检索出来。排除多器官切除术。收集患者数据、诊断数据、先前手术和新辅助治疗数据、围手术期和手术数据、逻辑数据和短期结果。使用多变量分析（多元线性和逻辑回归）来评估两种切除方法在调整所有潜在混杂因素后的几个结果之间的差异。结果以连续变量的调整平均差异或二分类变量的调整优势比（OR）表示。
共确定了 352 例直肠癌患者：168 例机器人和 184 例传统腹腔镜病例，由外科医生 A 手术 178 例，由外科医生 B 手术 174 例。机器人组的平均手术时间为 215 分钟，比腹腔镜组的 175 分钟长 40 分钟（95%CI 24-56；p<0.0005）。机器人治疗的转化率明显较低（OR 0.09（0.03-0.32）；p<0.0005）和其他并发症（排除 SSI 和吻合口漏）（OR 0.32（0.15-0.69）；p=0.004），调整了潜在的混杂因素。
我们的研究表明，经验丰富的腹腔镜直肠癌外科医生进行的机器人手术与传统腹腔镜手术相比，大大提高了转化率和并发症发生率，但手术时间较长。
