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右半结肠切除术:连续100例接受腹腔镜和机器人技术治疗恶性肿瘤的患者。单一中心的累积经验。

Right colectomy: consecutive 100 patients treated with laparoscopic and robotic technique for malignancy. Cumulative experience in a single centre.

作者信息

Mégevand J L, Amboldi M, Lillo E, Lenisa L, Ganio E, Ambrosi A, Rusconi A

机构信息

Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, Italy.

Vita-Salute San Raffaele University, 20132, Milan, Italy.

出版信息

Updates Surg. 2019 Mar;71(1):151-156. doi: 10.1007/s13304-018-0599-0. Epub 2018 Nov 17.

Abstract

Robotic-assisted resections prove beneficial in overcoming potential limitation of laparoscopy, but clear evidences on patient's benefits are still lacking. We report our experience on 100 consecutive patients who underwent right colectomy with either robotic or laparoscopic approaches. Data were prospectively collected on a dedicated database (ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results). Median total operative time was 160 min in LS group (IQR = 140-180) and 204 min for RS group (IQR = 180-230). Median time to first flatus was 2.5 days for LS group (IQR = 2 - 3) and 2 days for RS group (IQR = 1-2). Length of stay (median) was 8 days in LS group (IQR = 6-10) and 5 days in RS group (IQR = 5-7). No statistically significant difference was found between the 2 groups when the number of harvested nodes, the anastomotic leakage and the postoperative bleeding were analyzed. The 30-day mortality was 0% in LS and RS groups. Conversion rate for LS group was 14% (7/50 pts) and for RS group was 0% (0/50). Minimally invasive surgery is a feasible and safe technique. The RS may overcome some technical limitations of laparoscopic surgery and it achieves the same oncological results compared to LS but with higher costs. The lower conversion rate allows to expect better clinical outcomes and lower complication rate.

摘要

机器人辅助切除术在克服腹腔镜手术的潜在局限性方面被证明是有益的,但关于患者获益的明确证据仍然缺乏。我们报告了100例连续接受机器人或腹腔镜右半结肠切除术患者的经验。数据前瞻性收集于一个专用数据库(美国麻醉医师协会评分、年龄、手术时间、中转率、再次手术率、早期并发症、住院时间和病理结果)。腹腔镜手术组(LS组)的中位总手术时间为160分钟(四分位间距IQR = 140 - 180),机器人手术组(RS组)为204分钟(IQR = 180 - 230)。LS组首次排气的中位时间为2.5天(IQR = 2 - 3),RS组为2天(IQR = 1 - 2)。LS组的住院时间(中位)为8天(IQR = 6 - 10),RS组为5天(IQR = 5 - 7)。分析所获淋巴结数量、吻合口漏和术后出血情况时,两组之间未发现统计学显著差异。LS组和RS组的30天死亡率均为0%。LS组的中转率为14%(7/50例患者),RS组为0%(0/50)。微创手术是一种可行且安全的技术。机器人手术可能克服腹腔镜手术的一些技术局限性,与腹腔镜手术相比,它能达到相同的肿瘤学效果,但成本更高。较低的中转率预示着更好的临床结局和更低的并发症发生率。

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