Fransgaard Tina, Pinar Ismail, Thygesen Lau Caspar, Gögenur Ismail
Zealand University Hospital, Department of Surgery, Lykkebækvej 1, 4600 Køge, Denmark.
Zealand University Hospital, Department of Surgery, Lykkebækvej 1, 4600 Køge, Denmark.
Surg Oncol. 2018 Jun;27(2):177-184. doi: 10.1016/j.suronc.2018.03.003. Epub 2018 Mar 27.
Resection quality after robot-assisted surgery for colorectal cancer have not previously been investigated in a nationwide study. The aim of the study was to examine the resection quality in robot-assisted versus laparoscopic surgery for colorectal cancer. Furthermore, 30-day mortality, postoperative complications, and conversion to open surgery were investigated.
Patients undergoing either laparoscopic or robot-assisted surgery for colorectal cancer between 1 January 2010 and 31 December 2015 were included. The primary outcome was whether R0 resection was achieved. Secondary outcomes were 30-day mortality, postoperative complications, and conversions to laparotomy.
A total of 8615 and 3934 patients had a diagnosis of colon cancer and rectal cancer respectively. Of the patients with colon cancer, 511 patients underwent robot-assisted surgery and of the patients with rectal cancer, 706 patients underwent robot-assisted surgery. In the multivariate analysis, patients with colon cancer had an odds ratio (OR) = 0.63 (95%CI 0.45-0.88) for receiving R0 resection in the robot-assisted group compared to laparoscopy. For patients with rectal cancer, the OR was 1.20 (95%CI 0.89-1.61). No difference in 30-day mortality or postoperative complications were observed. The OR of conversion to laparotomy was lower in the robot-assisted group compared to the laparoscopic group in both patients with colon - and rectal cancer.
The study showed significant lower odds of receiving R0 resection in patients with colon cancer undergoing robot-assisted surgery. In patients with rectal cancer the robot-assisted surgery non-significantly increased the odds of receiving R0 resection.
此前尚未在全国性研究中对机器人辅助结直肠癌手术的切除质量进行调查。本研究的目的是检查机器人辅助手术与腹腔镜手术治疗结直肠癌的切除质量。此外，还对30天死亡率、术后并发症及中转开腹手术情况进行了调查。
纳入2010年1月1日至2015年12月31日期间接受腹腔镜或机器人辅助结直肠癌手术的患者。主要结局是是否实现R0切除。次要结局是30天死亡率、术后并发症及中转开腹手术情况。
分别有8615例和3934例患者被诊断为结肠癌和直肠癌。在结肠癌患者中，511例接受了机器人辅助手术；在直肠癌患者中，706例接受了机器人辅助手术。多因素分析显示，与腹腔镜手术相比，机器人辅助组结肠癌患者接受R0切除的比值比（OR）为0.63（95%CI 0.45 - 0.88）。直肠癌患者的OR为1.20（95%CI 0.89 - 1.61）。未观察到30天死亡率或术后并发症存在差异。在结肠癌和直肠癌患者中，机器人辅助组中转开腹手术的OR均低于腹腔镜组。
该研究表明，接受机器人辅助手术的结肠癌患者获得R0切除的几率显著降低。在直肠癌患者中，机器人辅助手术获得R0切除的几率虽有增加，但无显著差异。
