机器人辅助手术在结直肠癌中的肿瘤学和外科安全性：一项纵向前瞻性队列研究的结果。
The oncological and surgical safety of robot-assisted surgery in colorectal cancer: outcomes of a longitudinal prospective cohort study.
机构信息
Department of surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Department of gastro-intestinal and oncologic surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
出版信息
Surg Endosc. 2019 Nov;33(11):3644-3655. doi: 10.1007/s00464-018-06653-2. Epub 2019 Jan 28.
BACKGROUND
Colorectal cancer is one of the most common cancers worldwide. Laparoscopic colorectal surgery (LCRS) is a frequently used modality. A new development in minimally invasive surgery is robot-assisted colorectal surgery (RACRS).
METHODS
Prospectively collected data of 378 consecutive patients who underwent RACRS or LCRS for stage I-III colorectal cancer from Dec 2014 to Oct 2017 were analyzed. Primary outcome was oncological outcome (radical margins, number of retrieved lymph nodes, locoregional recurrence). Secondary outcomes were distant metastases, overall and disease-free survival, operation time, conversion, length of hospital stay, and intra- and post-operative complications.
RESULTS
206 RACRS (129 colon and 77 rectal) and 172 LCRS (138 colon and 34 rectal) procedures were included. Baseline characteristics were similar. Overall median follow-up time was 15 months (0.2-36). Oncological outcome was similar. In colon cancer, radical margins were achieved in 99.3% in RACRS group versus 98.6% in LCRS group (p = 0.60), the average number of harvested lymph nodes was 16 ± 6 versus 18 ± 7 (p = 0.16), and locoregional recurrence rate in 24 months was 3.8% vs 3.8% (p = 0.99), respectively. In rectal cancer, radical margins were achieved in 89.6% in RACRS group versus 94.3% in LCRS group (p = 0.42), the average number of harvested lymph nodes was 16 ± 8 versus 15 ± 4 (p = 0.51), and locoregional recurrence rate in 24 months was 9.5 versus 5.6% (p = 0.42), respectively. Incidence of metastasis, survival rates, operation time, length of hospital stay, and number of severe post-operative complications measured by Clavien-Dindo scores did not differ between RACRS and LCRS groups. Conversion and intra-operative complication rates were significantly lower in the RACRS group as compared to the LCRS group (3% vs 9%, p = 0.008 and 2% vs 8%, p = 0.003, respectively).
CONCLUSION
RACRS is safe in the treatment of patients with stage I-III colorectal cancer. Oncological outcome did not differ between RACRS and LCRS groups. RACRS had lower conversion and intra-operative complication rates.
背景
结直肠癌是全球最常见的癌症之一。腹腔镜结直肠手术（LCRS）是一种常用的治疗方法。微创外科的一个新发展是机器人辅助结直肠手术（RACRS）。
方法
前瞻性收集了 2014 年 12 月至 2017 年 10 月期间接受 RACRS 或 LCRS 治疗 I-III 期结直肠癌的 378 例连续患者的数据。主要结局是肿瘤学结局（切缘是否为根治性、淋巴结检出数量、局部区域复发）。次要结局包括远处转移、总生存和无病生存、手术时间、中转率、住院时间以及术中术后并发症。
结果
共纳入 206 例 RACRS（129 例结肠和 77 例直肠）和 172 例 LCRS（138 例结肠和 34 例直肠）。两组基线特征相似。中位随访时间为 15 个月（0.2-36）。肿瘤学结局相似。在结肠癌中，RACRS 组的根治性切缘率为 99.3%，LCRS 组为 98.6%（p=0.60），平均淋巴结检出数量为 16±6 个，LCRS 组为 18±7 个（p=0.16），24 个月局部区域复发率分别为 3.8%和 3.8%（p=0.99）。在直肠癌中，RACRS 组的根治性切缘率为 89.6%，LCRS 组为 94.3%（p=0.42），平均淋巴结检出数量为 16±8 个，LCRS 组为 15±4 个（p=0.51），24 个月局部区域复发率分别为 9.5%和 5.6%（p=0.42）。RACRS 和 LCRS 组的远处转移发生率、生存率、手术时间、住院时间和 Clavien-Dindo 评分衡量的严重术后并发症数量无差异。与 LCRS 组相比，RACRS 组的中转率和术中并发症发生率显著降低（3% vs. 9%，p=0.008 和 2% vs. 8%，p=0.003）。
结论
RACRS 治疗 I-III 期结直肠癌是安全的。RACRS 组和 LCRS 组的肿瘤学结局无差异。RACRS 的中转率和术中并发症发生率较低。
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